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Published on: February 16, 2011
A resource-based assessment of trauma care in the United States
Avery B Nathens1, Gregory J Jurkovich, Ellen J MacKenzie
1Division of Trauma and General Surgery, Harborview Medical Center and Department of Surgery, University of Washington, Seattle, 98104-2499, USA. anathens@u.washington.edu
Background:
The resources needed and those available to support trauma care for a given region are currently unknown. Resource use and availability were evaluated for injured subjects across a large sample of the United States.
Methods:
This population-based study of trauma-related discharges in 18 states represented all four geographic regions of the United States. Hospital discharge and bed-utilization rates as a function of injury severity were assessed. Resource availability was evaluated by determining state trauma center density.
Results:
This study evaluated 523,780 trauma patients discharged from 2,317 hospitals. The discharge rate for all trauma was 412 per 100,000 person-years, whereas the rate for major trauma was only 44 per 100,000 person-years. More than one third of the patients with major trauma received care at centers not designated for trauma care. The hospital bed utilization rate was 2,095 days per 100,000 person-years. The availability of trauma centers varied greatly across states, ranging from 0.9 to 6.6 centers per million population.
Conclusions:
A substantial minority of major trauma patients in the United States are treated in nondesignated trauma centers. The variability in the availability of trauma resources indicates a lack of consensus with respect to the resources required for trauma system implementation.
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