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The American College of Surgeons Needs-Based Assessment of Trauma Systems: Estimates for the State of California

Uribe-Leitz, Tarsicio MD; Esquivel, Micaela M. MD; Knowlton, Lisa M. MD; Ciesla, David MD; Lin, Feng MS; Hsia, Renee Y. MD; Spain, David A. MD; Winchell, Robert J. MD; Staudenmayer, Kristan L. MD

Journal of Trauma and Acute Care Surgery: May 2017 - Volume 82 - Issue 5 - p 861–866
doi: 10.1097/TA.0000000000001408
AAST 2016 Plenary Paper
Editor's Choice

BACKGROUND In 2015, the American College of Surgeons Committee on Trauma convened a consensus conference to develop the Needs-Based Assessment of Trauma Systems (NBATS) tool to assist in determining the number of trauma centers required for a region. We tested the performance of NBATS with respect to the optimal number of trauma centers needed by region in California.

METHODS Trauma center data were obtained from the California Emergency Services Authority Information Systems (CEMSIS). Numbers of admitted trauma patients (ISS > 15) were obtained using statewide nonpublic admissions data from the California Office of Statewide Health Planning and Development (OSHPD), CEMSIS, and data from local emergency medical service agency (LEMSA) directors who agreed to participate in a telephone survey. Population estimates per county for 2014 were obtained from the U.S. Census. NBATS criteria used included population, transport time, community support, and number of discharges for severely injured patients (ISS > 15) at nontrauma centers and trauma centers. Estimates for the number of trauma centers per region were created for each of the three data sources and compared to the number of existing centers.

RESULTS A total of 62 state-designated trauma centers were identified for California: 13 (21%) Level I, 36 (58%) Level II, and 13 (11%) Level III. NBATS estimates for the total number of trauma centers in California were 27% to 47% lower compared to the number of trauma centers in existence, but this varied based on urban/rural status. NBATS estimates were lower than the current state in 70% of urban areas but were higher in almost 90% of rural areas. All data sources (OSHPD, CEMSIS, local data) produced similar results.

CONCLUSION Estimates from the NBATS tool are different from what is currently in existence in California, and differences exist based on whether the region is rural or urban. Findings from the current study can help inform future iterations of the NBATS tool.

LEVEL OF EVIDENCE Economic, level V.

From the Section of Acute Care Surgery (T.U.L., M.M.E., L.M.K., D.A.S, K.L.S.), Department of Surgery, Stanford University, Stanford, California; Division of Acute Care Surgery (D.C.), Department of Surgery, University of South Florida College of Medicine, Tampa, Florida; Department of Emergency Medicine and Philip R. Lee Institute of Health Policy (F.L., R.Y.H.), University of California San Francisco, San Francisco, California; and Division of Trauma, Burns, Critical and Acute Care (R.J.W.), Department of Surgery, Weill Cornell Medicine, New York, New York.

Submitted: September 1, 2016, Revised: December 2, 2016, Accepted: December 19, 2016, Published online: February 28, 2017.

This paper was presented at the 75th Annual Meeting of the American Association for the Surgery of Trauma, September 14–17, 2016, in Waikoloa, Hawaii.

Address for reprints: Kristan L. Staudenmayer, MD, MS, 300 Pasteur Drive, Grant Building, S067, Stanford, CA 94305; email:

© 2017 Lippincott Williams & Wilkins, Inc.