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Distance matters: Effect of geographic trauma system resource organization on fatal motor vehicle collisions

Brown, Joshua B. MD, MSc; Rosengart, Matthew R. MD, MPH; Billiar, Timothy R. MD; Peitzman, Andrew B. MD; Sperry, Jason L. MD, MPH

Journal of Trauma and Acute Care Surgery: July 2017 - Volume 83 - Issue 1 - p 111–118
doi: 10.1097/TA.0000000000001508
EAST Plenary Paper

BACKGROUND: Trauma systems improve outcome; however, it is unclear how geographic organization of trauma system resources (TSR) affects outcome. Our objective was to evaluate the relationship of fatal motor vehicle collision (MVC) rates and the distance from individual MVC locations to the nearest TSR as a measure of the geographical organization of trauma systems, as well as how theoretical changes in the distribution of TSR may affect fatal MVC rates.

METHODS: All fatal MVC in Pennsylvania 2013–2014 were mapped from the Fatality Analysis Reporting System database. Deaths on scene were excluded. TSR including trauma centers and helicopter bases were mapped. Distance between each fatal MVC and nearest TSR was calculated. The primary outcome was fatal MVC rate per 100 million vehicle miles traveled (VMT). Empiric Bayes kriging and hot spot analysis were performed to evaluate geographic patterns in fatal MVC rates. Association between fatal MVC rate and distance to the nearest TSR was evaluated with linear regression. Spatial lag regression evaluated this association while controlling for MVC and county-level characteristics.

RESULTS: We identified 886 fatalities from 863 fatal MVC. Median fatal MVC rate was 0.187 per 100 million VMT. Higher fatal MVC rates and fatality hot spots occur in locations farther from TSR. The fatal MVC rate increased 0.141 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). When controlling for confounders, the fatal MVC rate increased by 0.089 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). If two helicopters stationed at trauma centers were relocated into the highest fatality regions, our model predicts a 12.3% relative reduction in the overall MVC fatality rate.

CONCLUSIONS: Increasing distance to the nearest TSR is associated with increasing fatal MVC rate. The geographic organization of trauma systems may impact outcome, and geospatial analysis can allow data-driven changes to potentially improve outcome.

LEVEL OF EVIDENCE: Prognostic/Epidemiologic, level III; Case management, level III.

From the Division of Trauma and General Surgery, Department of Surgery (J.B.B., M.R.R., T.R.B., A.B.P., J.L.S.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Submitted: November 30, 2016, Revised: January 25, 2017, Accepted: February 13, 2017, Published online: April 18, 2017.

This paper was presented as an oral podium presentation at the 30th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, January 10–14, 2017, in Hollywood, FL.

Address for reprints: Joshua B. Brown, MD, MSc, Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213; email:

© 2017 Lippincott Williams & Wilkins, Inc.