A Resource-Based Assessment of Trauma Care in the United States

Background: The resources needed and those available to support trauma care for a given region are currently unknown. Resource use and availability were evaluated for injured subjects across a large sample of the United States. Methods. This population-based study of trauma-related discharges in 18 states represented all four geographic regions of the United States. Hospital discharge and bed-utilization rates as a function of injury severity were assessed. Resource availability was evaluated by determining state trauma center density. Results. This study evaluated 523,780 trauma patients discharged from 2,317 hospitals. The discharge rate for all trauma was 412 per 100,000 person-years, whereas the rate for major trauma was only 44 per 100,000 person-years. More than one third of the patients with major trauma received care at centers not designated for trauma care. The hospital bed utilization rate was 2,095 days per 100,000 person-years. The availability of trauma centers varied greatly across states, ranging from 0.9 to 6.6 centers per million population. Conclusions. A substantial minority of major trauma patients in the United States are treated in nondesignated trauma centers. The variability in the availability of trauma resources indicates a lack of consensus with respect to the resources required for trauma system implementation.