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Geographic distribution of severely injured patients: Implications for trauma system development

Ciesla, David J. MD; Pracht, Etienne E. PhD; Cha, John Y. MD; Langland-Orban, Barbara PhD

Journal of Trauma and Acute Care Surgery: September 2012 - Volume 73 - Issue 3 - p 618–624
doi: 10.1097/TA.0b013e3182509132
WTA 2011 Plenary Papers

BACKGROUND Despite decades of trauma system development, many severely injured patients fail to reach a trauma center for definitive care. The purpose of this study was to define the regions served by Florida’s designated trauma centers and define the geographic distribution of severely injured patients who do not access the state’s trauma system.

METHODS Severely injured patients discharged from Florida hospitals were identified using the 2009 Florida Agency for Health Care Administration database. The home zip codes of patients discharged from trauma and nontrauma center hospitals were used as a surrogate for injury location and plotted on a map. A radial distance containing 75% of trauma center discharges defined trauma center catchment area.

RESULTS Only 52% of severely injured patients were discharged from trauma centers. The catchment areas varied from 204 square miles to 12,682 square miles and together encompassed 92% state’s area. Although 93% of patients lived within a trauma center catchment area, the proportion treated at a trauma center in each catchment area varied from 13% to 58%. Mapping of patient residences identified regions of limited access to the trauma system despite proximity to trauma centers.

CONCLUSIONS The distribution of severely injured patients who do not reach trauma centers presents an opportunity for trauma system improvement. Those in proximity to trauma centers may benefit from improved and secondary triage guidelines and interfacility transfer agreements, whereas those distant from trauma centers may suggest a need for additional trauma system resources.

LEVEL OF EVIDENCE Epidemiologic study, level III.

From the Department of Surgery (D.J.C., J.Y.C.), University of South Florida College of Medicine; and Department of Health Policy and Management (E.E.P., B.L.O.), University of South Florida College of Public Health, Tampa, Florida.

Submitted: July 15, 2011, Revised: January 19, 2012, Accepted: February 6, 2012. Published online: May 2, 2012.

Presented at the 41st Meeting of the Western Trauma Association, February 27–March 4, 2011, in Big Sky, Montana.

Address for reprints: David J. Ciesla, MD, Tampa General Hospital, University of South Florida, 2 Tampa General Cir, G417, Tampa, FL 33606; email:

© 2012 Lippincott Williams & Wilkins, Inc.