Regionalized trauma care system in Texas: implications for redesigning trauma systems.

Background: The aim of this investigation was to evaluate the theoretical framework of regionalized trauma care that places highest expertise at Level I and II Trauma Centers.

Material/methods: To document appropriateness of regionalization the authors examined outcomes of all injured cases hospitalized over 2 years in trauma centers in Texas. The outcome measure was survival following an injury for cases that were treated in any trauma center.

Results: Survival was disproportionately lower at Level II and mostly Level I centers compared to centers with lower expertise. When adjusting for severity the difference in survival between centers was of smaller amplitude. Moreover, survival among the cases transferred to Level I and II trauma centers did not differ when adjusting for severity and mortality risk. Patients older than 45, of Hispanic origin, and with some type of insurance were less likely to survive at these centers. Lower survival was associated with shorter length of hospital stay and increased severity.

Conclusions: The study raises the question whether regionalization in its current form is the appropriate framework for the organization of trauma care in Texas. Small variation in survival among trauma centers with highest expertise, indicate the need to revisit the entire concept of regionalized trauma care or particular elements of its structure. One solution suggested here is to have multiple centers with similar expertise at the core of the system acting as "Trauma Hospitals" which would connect with all the other hospitals in the region regardless of their expertise in an integrative model.