Skip Navigation LinksHome > March 2014 - Volume 76 - Issue 3 > Unregulated proliferation of trauma centers undermines cost...
Journal of Trauma and Acute Care Surgery:
doi: 10.1097/TA.0000000000000125
AAST 2013 Plenary Papers

Unregulated proliferation of trauma centers undermines cost efficiency of population-based injury control

Tepas, Joseph J. MD; Kerwin, Andrew J. MD; Ra, Jin Hee MD

Collapse Box

Abstract

BACKGROUND

We evaluated the impact on coverage and regional cost of trauma care produced by the activation of a Level II center with no preceding needs analysis in an established trauma region with a Level I center.

METHODS

Patient deidentified trauma registry data for years 2010, 2011, and 2012 were analyzed to assess the effect on trauma service volume during a period at the midpoint of which the Level II center was activated. Trends for each year were evaluated by patient volume, mechanism, resource use as reflected in a transfer to the intensive care unit (ICU) and ICU stay, patient severity as defined by Injury Severity Score (ISS), and patient injury profile determined by mean body region Abbreviated Injury Scale (AIS) score.

RESULTS

Between 2010 and 2011, during which the Level II opened, overall volume at the Level I center dropped by 3.7%, and blunt volume remained unchanged. From 2011 to 2012, overall Level I volume dropped by 9.4%, and blunt injury fell by 14%. Proportions requiring immediate operating room or ICU care did not change. ISS distribution at the Level I center across the years was similar. Head, chest, and abdominal injuries, as assessed by AIS body region, increased slightly in severity and decreased in volume by 25%, 17%, and 18%, respectively. For 2012, the new center publically reported treating 1,100 patients, which, in concert with the Level I decrease, translates to increasing regional trauma center access by 25% while increasing expense of necessary core personnel by 217%.

CONCLUSION

Addition of a second trauma center in a stable region, in which injury incidence was actually decreasing, doubled the cost of personnel, one of the most expensive components of the trauma system and decreased the volume of injuries necessary for training and education. Trauma system expansion must be based on needs assessment, which assures system survival and controls societal cost.

LEVEL OF EVIDENCE

Economic & value-based evaluation, level III.

Copyright © 2014 by Lippincott Williams & Wilkins

Follow Us


Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.