The Impact of Geographic Distribution on Trauma Center Outcomes: Do Center Outcomes Vary by Region?

Background: The American College of Surgeons (ACS) publishes Resources for Optimal Care of the Injured Patient (Orange Book) to provide common requirements to verify trauma centers (TCs), throughout the United States. There are very few studies that assess the impact of geography on TC outcomes. Our study aimed to evaluate the differences in geographic regions in terms of injury-adjusted all-cause mortality at ACS Level 1, 2, and 3 TCs.

Methods: Review of the 2016 Research Data Set provided by the National Trauma Data Bank. TCs were categorized by the Research Data Set into geographic regions: Northeast, Midwest, South, and West. TCs were subcategorized into ACS Level 1, 2, or 3; all others were excluded. Injury-adjusted mortality was determined using observed/expected mortality (O/E) ratios, derived from TRISS methodology. Chi-squared and t-test analyses were used with significance defined as P-value<0.05.

Results: Among Level 1 TCs, the West (O/E = 0.62) and South (0.61) regions had significantly higher adjusted mortality rates than the Level 1s in the Midwest (0.52) and Northeast (0.52) (P < 0.05). Among Level 2s, the West (O/E = 0.61) and South (0.55) regions had significantly higher mortality than the Level 2s in the Midwest (0.40) and Northeast (0.35) (P < 0.05). Among Level 3 TCs, the South (O/E = 0.48) and the West (0.43) had significantly higher mortality than the Midwest (0.26) and Northeast (0.22) (P < 0.05).

Conclusions: In the United States, injury-adjusted all-cause mortality rates are significantly higher in the South and West regions for ACS Level 1, 2, and 3 TCs compared with the Midwest and Northeast. This geographic disparity necessitates a deeper evaluation.