Fifteen-Year Trauma System Performance Analysis Demonstrates Optimal Coverage for Most Severely Injured Patients and Identifies a Vulnerable Population

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Fifteen-Year Trauma System Performance Analysis Demonstrates Optimal Coverage for Most Severely Injured Patients and Identifies a Vulnerable Population David J. Ciesla, MD, FACS, Joseph J. Tepas, MD, FACS, Etienne E. Pracht, PhD, Barbara Langland-Orban, MD, John Y. Cha, MD, FACS, Lewis M. Flint, MD, FACS Journal of the American College of Surgeons Volume 216, Issue 4, Pages 687-695 (April 2013) DOI: 10.1016/j.jamcollsurg.2012.12.033 Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 1 Annual discharges for (A) all injured patients and (B) severely injured patients. Annual injury discharges increased in the elderly and adults but decreased for children. Severe injury discharges increased for the elderly and adults but decreased in children. Light gray, elderly; dark gray, adult; black, children. Journal of the American College of Surgeons 2013 216, 687-695DOI: (10.1016/j.jamcollsurg.2012.12.033) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 2 (A) The number of injury discharges increased for nontrauma centers (NTC; model: x = 1,065.51 ± 92.33; p < 0.01) and designated trauma centers (DTC; model: x = 1,413.17 ± 77.04; p < 0.01). (B) The number of severe injury discharges increased for DTC (model: x = 356.31 ± 33.54; p < 0.01) but decreased for NTC (model: x = −82.19 ± 24.04; p < 0.01). By 2010, 35% of injured patients and 64% of severely injured patients were discharged from DTCs. Journal of the American College of Surgeons 2013 216, 687-695DOI: (10.1016/j.jamcollsurg.2012.12.033) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 3 (A) The number of injured patients/center increased for DTC (model: x = 47.97 ± 4.21; p < 0.01) and NTC (model: x = 10.66 ± 0.75; p < 0.01). (B) The number of severely injured patients/center increased for DTC (model: x = 12.51±1.73; p < 0.01) but did not change for NTC (model: x = −0.08 ± 0.11; p = 0.51). DTC, designated trauma centers; NTC, nontrauma centers. Journal of the American College of Surgeons 2013 216, 687-695DOI: (10.1016/j.jamcollsurg.2012.12.033) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 4 Proportion of (A) all injured and (B) severely injured patients discharged from DTC stratified by age category. The proportion of injured patients and severely injured patients discharged from trauma centers increased for all age groups. DTC, designated trauma centers; NTC, nontrauma centers. Journal of the American College of Surgeons 2013 216, 687-695DOI: (10.1016/j.jamcollsurg.2012.12.033) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 5 Geographic distribution of severely injured patients discharged from designated trauma centers (DTC; blue dot) and nontrauma centers (NTC; red dot) in 2010. Green dots denote trauma center locations. Journal of the American College of Surgeons 2013 216, 687-695DOI: (10.1016/j.jamcollsurg.2012.12.033) Copyright © 2013 American College of Surgeons Terms and Conditions