新创伤中心提供必要还是多余的服务？全国范围分析。
Do new trauma centers provide needed or redundant access? A nationwide analysis.
机构信息
From the Department of Surgery (A.C.F., J.A.F., J.A.C., E.S.T., L.R.B., V.P.H.), Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center; Digestive Disease and Surgery Institute (A.C.F.), Cleveland Clinic Foundation; and Department of Population and Quantitative Health Sciences (J.C., V.P.H.), Case Western Reserve University School of Medicine, Cleveland, Ohio.
出版信息
J Trauma Acute Care Surg. 2022 Sep 1;93(3):347-352. doi: 10.1097/TA.0000000000003652. Epub 2022 May 30.
BACKGROUND
Our prior research has demonstrated that increasing the number of trauma centers (TCs) in a state does not reliably improve state-level injury-related mortality. We hypothesized that many new TCs would serve populations already served by existing TCs, rather than in areas without ready TC access. We also hypothesized that new TCs would also be less likely to serve economically disadvantaged populations.
METHODS
All state-designated adult TCs registered with the American Trauma Society in 2014 and 2019 were mapped using ArcGIS Pro (ESRI Inc., Redlands, CA). Trauma centers were grouped as Level 1 or 2 (Lev12) or Level 3, 4 or 5 (Lev345). We also obtained census tract-level data (73,666 tracts), including population counts and percentage of population below the federal poverty threshold. Thirty-minute drive-time areas were created around each TC. Census tracts were considered "served" if their geographic centers were located within a 30-minute drive-time area to any TC. Data were analyzed at the census tract level.
RESULTS
A total of 2,140 TCs were identified in 2019, with 256 new TCs and 151 TC closures. Eighty-two percent of new TCs were Levels 3 to 5. Nationwide, coverage increased from 75.3% of tracts served in 2014 to 78.1% in 2019, representing an increased coverage from 76.0% to 79.4% of the population. New TC served 17,532 tracts, of which 87.3% were already served. New Lev12 TCs served 9,100 tracts, of which 91.2% were already served; new Lev345 TCs served 15,728 tracts, of which 85.9% were already served. Of 2,204 newly served tracts, those served by Lev345 TCs had higher mean percentage poverty compared with those served by Lev12 TCs (15.7% vs. 13.2% poverty, p < 0.05).
DISCUSSION
Overall, access to trauma care has been improving in the United States. However, the majority of new TCs opened in locations with preexisting access to trauma care. Nationwide, Levels 3, 4, and 5 TCs have been responsible for expanding access to underserved populations.
LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level IV.
背景
我们之前的研究表明，增加一个州的创伤中心（TC）数量并不能可靠地提高该州与伤害相关的死亡率。我们假设许多新的 TC 将为现有的 TC 服务的人群提供服务，而不是在没有现成 TC 服务的地区提供服务。我们还假设新的 TC 也不太可能为经济困难的人群提供服务。
方法
2014 年和 2019 年，所有经美国创伤协会指定的成年 TC 都使用 ArcGIS Pro（ESRI Inc.，加利福尼亚州雷德兰兹）进行了映射。TC 分为 1 级或 2 级（Lev12）或 3 级、4 级或 5 级（Lev345）。我们还获得了人口普查区层面的数据（73666 个普查区），包括人口数量和低于联邦贫困线的人口比例。为每个 TC 创建了 30 分钟车程的区域。如果地理中心位于任何 TC 的 30 分钟车程区域内，则认为普查区“得到了服务”。数据在普查区层面进行分析。
结果
2019 年共确定了 2140 个 TC，其中 256 个是新 TC，151 个 TC 关闭。82%的新 TC 是 3 级至 5 级。全国范围内，2014 年服务的普查区比例从 75.3%增加到 2019 年的 78.1%，代表着从 76.0%到 79.4%的人口得到了服务。新 TC 服务了 17532 个普查区，其中 87.3%已经得到了服务。新的 Lev12 TC 服务了 9100 个普查区，其中 91.2%已经得到了服务；新的 Lev345 TC 服务了 15728 个普查区，其中 85.9%已经得到了服务。在 2204 个新服务的普查区中，Lev345 TC 服务的普查区的平均贫困率高于 Lev12 TC 服务的普查区（15.7%与 13.2%的贫困率，p < 0.05）。
讨论
总的来说，美国创伤护理的可及性一直在提高。然而，大多数新的 TC 都开设在已经可以获得创伤护理的地方。在全国范围内，3 级、4 级和 5 级 TC 一直负责扩大服务范围，以满足服务不足人群的需求。
证据水平
预后和流行病学；IV 级。
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