Overall deaths were significantly lower at Level III centers (Level I, 4% versus Level II, 4% versus Level III, 2%, p 14 years of age and had injury severity score (ISS) >15, were alive on admission and had at least one of the following severe injuries: aortic, vena cava, iliac vessels, cardiac, grade IV/V liver injuries, quadriplegia, or complex pelvic fractures. A total of 2,910 patients were seen at the 8 Level III centers. Acuity and severity of injuries were higher at Level I and II centers. A total of 24,392 patients from 26 trauma centers were examined, including all eight Level III centers. The experiences with chest, abdominal, and neurologic trauma were examined in detail.
Trauma admissions to the Level III centers were examined for acuity, severity, and type of injury. Demographics and patient care outcomes were assessed by level of designation. During a 2-year period in 20, the state trauma registry was queried on all trauma admissions for centers in the trauma system. The purpose of this retrospective study was to determine how Level III trauma centers compared with Level I and Level II centers in the Missouri trauma system and, secondly, how trauma surgeon experience at these centers might shape future educational efforts to optimize rural trauma care.
These centers are required to have the presence of a trauma team and trauma surgeon but do not require orthopedic or neurosurgical coverage. The cornerstone of rural trauma care is the state-designated Level III trauma center. The state of Missouri has designated three levels of trauma care. Little is known about the smaller, rural trauma centers and how they function both independently and as part of a larger trauma system. Trauma care at rural level III trauma centers in a state trauma system.Īlthough much has been written about the benefits of trauma center care, most experiences are urban with large numbers of patients. Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or when coordinating care within state or regional A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. We defined the need for critical trauma resources and interventions (" trauma center need") as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. The outcome variable was defined as the portion of treated patients who were critically injured.
We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443). Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Trauma center staffing, infrastructure, and patient characteristics that influence trauma center need.įaul, Mark Sasser, Scott M Lairet, Julio Mould-Millman, Nee-Kofi Sugerman, David
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