Limited Access to Trauma Centres Associated With Higher Prehospital Mortality

October 25, 2018

By Michael Bassett

BOSTON -- October 25, 2018 -- In states where patients have limited access to trauma-centre care, a greater number of injured patients die before they arrive at the hospital, according to research presented here at the 2018 Annual Meeting of the American College of Surgeons (ACS).

The frequency of these prehospital deaths contributes to higher overall trauma-related mortality, noted l Zain G. Hashmi, MD, Sinai Hospital, Baltimore, Maryland, on October 22.

Dr. Hashmi and former colleagues from Brigham and Women’s Hospital, Boston, Massachusetts, pointed out that >200,000 Americans die from injuries every year; trauma is the leading cause of death among Americans younger than 45 years.

In this study, the researchers analysed 1.95 million trauma deaths among US adults aged ≥15 years, as reported to the US Centers for Disease Control and Preventions (CDC) between 1999 and 2016 (CDC Wide-Ranging Online Data for Epidemiological Research). They found that 49% of the deaths occurred prehospital and 42% in the hospital. The other 9% included patients who were dead on arrival, as well as deaths in hospices and nursing homes.

An association was found between states with a “high prehospital death burden” and a low proportion of the population who lived within 1 hour of a level I or II trauma centre. Additionally, the researchers found that just 63.2% of the population in states with a high prehospital death burden had timely access to level I/II/III trauma centres versus 90.2% in the other states.

If every state had the same ratio of prehospital to in-hospital deaths as the top quartile of states with the best access to trauma centres, results demonstrated that there would be 7,601 fewer prehospital deaths annually. If all states provided that level of access to trauma-centre care, 130,000 lives could potentially have been saved over the 17 years included in the study, Dr. Hashmi noted.

The 28 states identified as having a high prehospital death burden are Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nevada, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Utah, West Virginia, Wisconsin, and Wyoming.

The American College of Surgeons has championed the goal of “Zero Preventable Deaths After Injury,” as recommended by a 2016 report from the National Academy of Sciences. Timely access to trauma centres is a key to achieving that goal, the researchers concluded.

[Presentation title: Access Delayed Is Access Denied: States With Higher Age-Adjusted Mortality Rates Have Poorer Access to Trauma Center Care]