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Level I Trauma Centers: More Is Not Necessarily Better.

Abstract The optimal number of level I trauma centers (L1TCs) in a region has not been elucidated. To begin addressing this, we compared mortalities for patients treated in counties or regions with 1 L1TC to those with >1 L1TC across Ohio. Ohio Trauma Registry data from 2010 to 2012 were analyzed. Patients with age ≥15 from counties/regions with L1TC were included. Region was defined as a L1TC containing county and its neighboring counties. Two analyses were performed. In the county analysis, counties containing 1 L1TC were compared with counties with multiple L1TCs. This comparison is repeated on a regional level for the regional analysis. Subgroup analyses were performed. 38,661 and 55,064 patients were in the county and regional analysis, respectively. Patients treated in counties or regions with multiple L1TCs were significantly younger (P < 0.001). Despite this, the mortality was similar for the two groups in the county analysis and significantly higher for regions with multiple L1TCs (P < 0.001). Multivariate logistic regression demonstrated that having multiple L1TC coverage in a region was an independent predictor for death (odds ratios: 1.17; 1.07-1.28; P = 0.001). Subgroup analyses showed that mortality in counties and regions with multiple L1TCs was not lower in any subgroups but was higher in patients with age ≥65 and patients with blunt injuries (P < 0.05). Having multiple L1TCs in a county was associated with increased mortality in certain patient subgroups. Having multiple L1TCs in a region was an independent predictor for death. These results should be considered carefully when designing future regionalized trauma networks. More L1TCs is not necessarily better.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 29712606
OWN - NLM
STAT- MEDLINE
DCOM- 20180509
LR  - 20180509
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 84
IP  - 4
DP  - 2018 Apr 1
TI  - Level I Trauma Centers: More Is Not Necessarily Better.
PG  - 557-564
AB  - The optimal number of level I trauma centers (L1TCs) in a region has not been
      elucidated. To begin addressing this, we compared mortalities for patients
      treated in counties or regions with 1 L1TC to those with &gt;1 L1TC across Ohio.
      Ohio Trauma Registry data from 2010 to 2012 were analyzed. Patients with age
      &gt;/=15 from counties/regions with L1TC were included. Region was defined as a L1TC
      containing county and its neighboring counties. Two analyses were performed. In
      the county analysis, counties containing 1 L1TC were compared with counties with 
      multiple L1TCs. This comparison is repeated on a regional level for the regional 
      analysis. Subgroup analyses were performed. 38,661 and 55,064 patients were in
      the county and regional analysis, respectively. Patients treated in counties or
      regions with multiple L1TCs were significantly younger (P &lt; 0.001). Despite this,
      the mortality was similar for the two groups in the county analysis and
      significantly higher for regions with multiple L1TCs (P &lt; 0.001). Multivariate
      logistic regression demonstrated that having multiple L1TC coverage in a region
      was an independent predictor for death (odds ratios: 1.17; 1.07-1.28; P = 0.001).
      Subgroup analyses showed that mortality in counties and regions with multiple
      L1TCs was not lower in any subgroups but was higher in patients with age &gt;/=65
      and patients with blunt injuries (P &lt; 0.05). Having multiple L1TCs in a county
      was associated with increased mortality in certain patient subgroups. Having
      multiple L1TCs in a region was an independent predictor for death. These results 
      should be considered carefully when designing future regionalized trauma
      networks. More L1TCs is not necessarily better.
FAU - He, Jack C
AU  - He JC
FAU - Sajankila, Nitin
AU  - Sajankila N
FAU - Kreiner, Laura A
AU  - Kreiner LA
FAU - Allen, Debra L
AU  - Allen DL
FAU - Claridge, Jeffrey A
AU  - Claridge JA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Health Services Accessibility/*statistics &amp; numerical data
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Ohio/epidemiology
MH  - Quality Indicators, Health Care/*statistics &amp; numerical data
MH  - Registries
MH  - Retrospective Studies
MH  - Trauma Centers/standards/*supply &amp; distribution
MH  - Wounds and Injuries/*mortality/therapy
MH  - Young Adult
EDAT- 2018/05/02 06:00
MHDA- 2018/05/10 06:00
CRDT- 2018/05/02 06:00
PHST- 2018/05/02 06:00 [entrez]
PHST- 2018/05/02 06:00 [pubmed]
PHST- 2018/05/10 06:00 [medline]
PST - ppublish
SO  - Am Surg. 2018 Apr 1;84(4):557-564.