Level I Trauma Centers: More Is Not Necessarily Better

Area of Science:

• Trauma Surgery
• Health Services Research
• Public Health

Background:

• The optimal number and distribution of Level I Trauma Centers (L1TCs) for regional trauma care remain unclear.
• Existing trauma networks may not be optimized for patient outcomes based on L1TC density.

Purpose of the Study:

• To compare patient mortality rates between counties and regions with single versus multiple Level I Trauma Centers (L1TCs) in Ohio.
• To determine if a higher density of L1TCs is associated with improved survival for trauma patients.

Main Methods:

• Analysis of the Ohio Trauma Registry data from 2010-2012 for patients aged 15 and older.
• Comparison of mortality rates in counties and defined regions (a L1TC county and its neighbors) with one versus multiple L1TCs.
• Multivariate logistic regression to identify independent predictors of mortality.

Main Results:

• Patients treated in areas with multiple L1TCs were younger but had similar or higher mortality rates compared to areas with a single L1TC.
• Multiple L1TC coverage in a region was an independent predictor of increased mortality (OR: 1.17).
• Subgroup analyses revealed no survival benefit; increased mortality was observed in older patients (≥65) and those with blunt injuries in multi-L1TC areas.

Conclusions:

• The presence of multiple Level I Trauma Centers within a region is not associated with improved patient survival and may be linked to increased mortality.
• Trauma network design should carefully consider the number and distribution of L1TCs, as 'more is not necessarily better'.