当前创伤中心的扩张模式并没有导致创伤后获得治疗的机会或死亡率的相应改善：一项生态学研究。
Current patterns of trauma center proliferation have not led to proportionate improvements in access to care or mortality after injury: An ecologic study.
机构信息
From the Division of Acute Care Surgery, Department of Surgery (S.A., J.S.B., T.O., G.A., A.K.M.) and Department of Radiology (J.S.B.), Larner College of Medicine, Burlington, Vermont; Department of Surgery (B.S.), University of Washington School of Medicine, Seattle, Washington; Larner College of Medicine at the University of Vermont, Burlington, Vermont (A.S.); Department of Mathematics and Statistics (D.H.), College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont; University of Texas Health Science Center (A.C.), Houston, Texas; and Division of Trauma, Burns, Acute and Critical Care, Department of Surgery (R.J.W.), Weill Cornell Medicine, New York, New York.
出版信息
J Trauma Acute Care Surg. 2023 Jun 1;94(6):755-764. doi: 10.1097/TA.0000000000003940. Epub 2023 Mar 7.
BACKGROUND
Timely access to high-level (I/II) trauma centers (HLTCs) is essential to minimize mortality after injury. Over the last 15 years, there has been a proliferation of HLTC nationally. The current study evaluates the impact of additional HLTC on population access and injury mortality.
METHODS
A geocoded list of HLTC, with year designated, was obtained from the American Trauma Society, and 60-minute travel time polygons were created using OpenStreetMap data. Census block group population centroids, county population centroids, and American Communities Survey data from 2005 and 2020 were integrated. Age-adjusted nonoverdose injury mortality was obtained from CDC Wide-ranging Online Data for Epidemiologic Research and the Robert Wood Johnson Foundation. Geographically weighted regression models were used to identify independent predictors of HLTC access and injury mortality.
RESULTS
Over the 15-year (2005-2020) study period, the number of HLTC increased by 31.0% (445 to 583), while population access to HLTC increased by 6.9% (77.5-84.4%). Despite this increase, access was unchanged in 83.1% of counties, with a median change in access of 0.0% (interquartile range, 0.0-1.1%). Population-level age-adjusted injury mortality rates increased by 5.39 per 100,000 population during this time (60.72 to 66.11 per 100,000). Geographically weighted regression controlling for population demography and health indicators found higher median income and higher population density to be positively associated with majority (≥50%) HLTC population coverage and negatively associated with county-level nonoverdose mortality.
CONCLUSION
Over the past 15 years, the number of HLTC increased 31%, while population access to HLTC increased only 6.9%. High-level (I/II) trauma center designation is likely driven by factors other than population need. To optimize efficiency and decrease potential oversupply, the designation process should include population level metrics. Geographic information system methodology can be an effective tool to assess optimal placement.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
背景
及时获得高水平（I/II）创伤中心（HLTC）对于最大限度地降低创伤后的死亡率至关重要。在过去的 15 年中，全国范围内的 HLTC 数量不断增加。本研究评估了额外的 HLTC 对人口获得和伤害死亡率的影响。
方法
从美国创伤学会获得具有年份指定的 HLTC 的地理编码列表，并使用 OpenStreetMap 数据创建 60 分钟旅行时间多边形。整合了 2005 年和 2020 年的普查块组人口质心、县人口质心和美国社区调查数据。从疾病预防控制中心广泛在线流行病学研究数据和罗伯特伍德约翰逊基金会获得年龄调整后的非过量伤害死亡率。使用地理加权回归模型确定 HLTC 获得和伤害死亡率的独立预测因素。
结果
在 15 年（2005-2020 年）的研究期间，HLTC 的数量增加了 31.0%（445 到 583），而人口获得 HLTC 的机会增加了 6.9%（77.5-84.4%）。尽管有所增加，但仍有 83.1%的县的获得机会没有变化，获得机会的中位数变化为 0.0%（四分位距，0.0-1.1%）。在此期间，人口水平的年龄调整伤害死亡率增加了 5.39/10 万（60.72 至 66.11/10 万）。在控制人口统计学和健康指标的地理加权回归中，发现较高的中位数收入和较高的人口密度与 HLTC 人口覆盖率的大部分（≥50%）呈正相关，与县一级的非过量死亡率呈负相关。
结论
在过去的 15 年中，HLTC 的数量增加了 31%，而人口获得 HLTC 的机会仅增加了 6.9%。高水平（I/II）创伤中心的指定可能是由人口需求以外的因素驱动的。为了提高效率并减少潜在的供应过剩，指定过程应包括人口水平指标。地理信息系统方法可以成为评估最佳位置的有效工具。
证据水平
预后和流行病学；IV 级。
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