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A Resource-Based Assessment of Trauma Care in the United States

Nathens, Avery B. MD, PhD, MPH; Jurkovich, Gregory J. MD; MacKenzie, Ellen J. PhD; Rivara, Frederick P. MD, MPH

The Journal of Trauma: Injury, Infection, and Critical Care: January 2004 - Volume 56 - Issue 1 - p 173-178
doi: 10.1097/01.TA.0000056159.65396.7C

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.

From the Division of Trauma and General Surgery, Harborview Medical Center, and the Department of Surgery, University of Washington, Seattle, Washington (A.B.N., G.J.J.), the Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington (A.B.N., G.J.J., F.P.R.), the Center for Injury Research and Policy, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland (E.J.M.), and the National Study on Costs and Outcomes of Trauma Care, Baltimore, Maryland (A.B.N., G.J.J., E.J.M., F.P.R.).

Submitted for publication July 11, 2002.

Accepted for publication December 6, 2002.

Funded by grant R49/CCR316840 from the Centers for Disease Control and Prevention.

Address for reprints: Avery B. Nathens, MD, PhD, MPH, Harborview Medical Center, Box 359796, 325 9th Avenue, Seattle, WA 98104-2499; email:

© 2004 Lippincott Williams & Wilkins, Inc.