From the Dell Medical School, The University of Texas at Austin, Austin, Texas (V.R.P.); Division of Acute Care Surgery, Department of Surgery (G.R., J.J., M.S., A.K., M.M., J.V.S., E.H., M.L., J.P.B.), Johns Hopkins University School of Medicine; Johns Hopkins School of Nursing (J.V.S., E.H.); Johns Hopkins Bloomberg School of Public Health (E.H., J.P.B.); Department of Emergency Medicine (M.L.), Johns Hopkins University, Baltimore, Maryland; Department of Surgery (A.B.N.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario; and Division of Acute Care Surgery, Department of Surgery (C.B.), University of Texas at Austin, Austin, Texas.
J Trauma Acute Care Surg. 2024 Aug 1;97(2):189-196. doi: 10.1097/TA.0000000000004221. Epub 2023 Dec 6.
Motor vehicle crashes (MVCs) are a leading cause of preventable trauma death in the United States. Access to trauma center care is highly variable nationwide. The objective of this study was to measure the association between geospatial access to trauma center care and MVC mortality.
This was a population-based study of MVC-related deaths that occurred in 3,141 US counties (2017-2020). American College of Surgeons and state-verified Level I to III trauma centers were mapped. Geospatial network analysis estimated the ground transport time to the nearest trauma center from the population-weighted centroid for each county. In this way, the exposure was the predicted access time to trauma center care for each county population. Hierarchical negative binomial regression measured the risk-adjusted association between predicted access time and MVC mortality, adjusting for population demographics, rurality, access to trauma resources, and state traffic safety laws.
We identified 92,398 crash fatalities over the 4-year study period. Trauma centers mapped included 217 Level I, 343 Level II, and 495 Level III trauma centers. The median county predicted access time was 47 minutes (interquartile range, 26-71 minutes). Median county MVC mortality was 12.5 deaths/100,000 person-years (interquartile range, 7.4-20.3 deaths/100,000 person-years). After risk-adjustment, longer predicted access times were significantly associated with higher rates of MVC mortality (>60 minutes vs. <15 minutes; mortality rate ratio 1.36; 95% confidence interval, 1.31-1.40). This relationship was significantly more pronounced in urban/suburban vs. rural/wilderness counties ( p for interaction, <0.001). County access to trauma center care explained 16% of observed state-level variation in MVC mortality.
Geospatial access to trauma center care is significantly associated with MVC mortality and contributes meaningfully to between-state differences in road traffic deaths. Efforts to improve trauma system organization should prioritize access to trauma center care to minimize crash fatalities.
Prognostic and Epidemiological, Level III.
机动车事故（MVC）是美国可预防创伤死亡的主要原因。全国范围内创伤中心的救治机会差异很大。本研究的目的是测量地理空间接近创伤中心治疗与 MVC 死亡率之间的关联。
这是一项基于人群的 MVC 相关死亡研究，涉及 2017-2020 年美国 3141 个县的死亡病例。美国外科医师学院和经州验证的一级至三级创伤中心都进行了映射。地理空间网络分析从每个县的人口加权质心估算了到最近创伤中心的地面运输时间。通过这种方式，暴露是每个县人口接受创伤中心治疗的预测可达时间。分层负二项式回归测量了预测可达时间与 MVC 死亡率之间的风险调整关联，调整了人口统计学特征、农村性、创伤资源获取情况和州交通安全法。
在 4 年的研究期间，我们确定了 92398 例撞车死亡病例。映射的创伤中心包括 217 个一级、343 个二级和 495 个三级创伤中心。中位数县预测可达时间为 47 分钟（四分位距，26-71 分钟）。中位数县 MVC 死亡率为 12.5 例/10 万人年（四分位距，7.4-20.3 例/10 万人年）。风险调整后，较长的预测可达时间与 MVC 死亡率的较高比率显著相关（>60 分钟与<15 分钟；死亡率比 1.36；95%置信区间，1.31-1.40）。在城市/郊区与农村/荒野县之间，这种关系更为显著（交互作用的 p 值<0.001）。创伤中心救治机会解释了 MVC 死亡率观察到的州间差异的 16%。
地理空间接近创伤中心的治疗与 MVC 死亡率显著相关，并对道路交通死亡的州间差异有重要贡献。改善创伤系统组织的努力应优先考虑创伤中心的救治机会，以尽量减少撞车死亡。
预后和流行病学，三级。
