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The association of trauma center closures with increased inpatient mortality for injured patients.

ABSTRACT: Trauma centers are an effective but costly element of the US health care infrastructure. Some Level I and II trauma centers regularly incur financial losses when these high fixed costs are coupled with high burdens of uncompensated care for disproportionately young and uninsured trauma patients. As a result, they are at risk of reducing their services or closing. The impact of these closures on patient outcomes, however, has not been previously assessed.We performed a retrospective study of all adult patient visits for injuries at Level I and II, nonfederal trauma centers in California between 1999 and 2009. Within this population, we compared the in-hospital mortality of patients whose drive time to their nearest trauma center increased as the result of a nearby closure with those whose drive time did not increase using a multivariate logit-linked generalized linear model. Our sensitivity analysis tested whether this effect was limited to a 2-year period following a closure.The odds of inpatient mortality increased by 21% (odds ratio, 1.21; 95% confidence interval, 1.04-1.40) among trauma patients who experienced an increased drive time to their nearest trauma center as a result of a closure. The sensitivity analyses showed an even larger effect in the 2 years immediately following a closure, during which patients with increased drive time had 29% higher odds of inpatient death (odds ratio, 1.29; 95% confidence interval, 1.11-1.51).Our results show a strong association between closure of trauma centers in California and increased mortality for patients with injuries who have to travel further for definitive trauma care. These adverse impacts were intensified within 2 years of a closure.Prognostic and epidemiologic, level III.

SUBMITTER: Hsia RY

PROVIDER: S-EPMC4217699 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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The association of trauma center closures with increased inpatient mortality for injured patients.

Hsia Renee Y RY Srebotnjak Tanja T Maselli Judith J Crandall Marie M McCulloch Charles C Kellermann Arthur L AL

The journal of trauma and acute care surgery 20140401 4

<h4>Background</h4>Trauma centers are an effective but costly element of the US health care infrastructure. Some Level I and II trauma centers regularly incur financial losses when these high fixed costs are coupled with high burdens of uncompensated care for disproportionately young and uninsured trauma patients. As a result, they are at risk of reducing their services or closing. The impact of these closures on patient outcomes, however, has not been previously assessed.<h4>Methods</h4>We perf ...[more]

PMID: 24625549

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Project description:ObjectiveTo examine sociodemographic predictors of trauma center (TC) transport of severely injured older adults.Data sourcesThe data source was the Healthcare Cost and Utilization Project, New York Inpatient Database (2014).Study designThis study was a secondary analysis of injured older adults. Key sociodemographic variables were age, gender, race/ethnicity, median household income, and primary payer. Confounding variables were injury severity, geographic location, number of chronic conditions, and injury mechanism. The outcome variable was TC transport.Data collection/extraction methodsThe database was filtered on the following criteria: age =/> 55 years, primary diagnosis of injury (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM], 800.0-957.9, excluding poisoning, late effects, and interfacility transfers), admitted to an acute care hospital in New York.Principal findingsRecords of 33 696 patients were included. Multivariate logistic regression analysis revealed that all variables were statistically significant predictors of TC transport except primary payer. Predictors of TC transport were as follows: higher injury severity (OR 2.1, CI 1.79-2.46; 3.39, CI 2.85-4.05); Asian/Pacific and Hispanic race/ethnicity (OR 2.51, CI 1.92-3.27; OR 1.1, CI 0.86-1.42), highest median household income (OR 1.24, CI 1.01-1.52), high population density (OR 1.32, CI 1.12-1.55; OR 3.2, CI 2.68-2.83), and vehicle crashes (OR 3.39, CI 2.79-4.11). Predictors of non-TC transport were as follows: older age groups (OR 0.92, CI 0.76-1.11; OR 0.79, CI 0.64-0.96; OR 0.77, CI 0.63-0.95), females (OR 0.65, CI 0.57-0.74), Black and "other" race (OR 0.75, CI 0.0.56-1.0; OR 0.96, CI 0.77-1.20), lower median household income (OR 0.76, CI 0.62-0.93; OR 0.86, CI 0.71-1.05), low population density (OR 0.96, CI 0.67-1.36; OR 0.89, CI 0.53-1.51), and number of chronic conditions (OR 0.89, CI 0.87-0.91).ConclusionsSociodemographic factors are a source of disparity for access to TCs. Further research is needed to confirm bias and test bias reduction strategies. Comprehensive education and policies are needed to reduce disparities in access to trauma care.

Dataset Information

The association of trauma center closures with increased inpatient mortality for injured patients.

Publications

The association of trauma center closures with increased inpatient mortality for injured patients.

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