title: A population-based study of the association of medical manpower with county trauma death rates in the United States.
abstract: OBJECTIVE
  To determine the association between measures of medical manpower available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availability of medical manpower to treat trauma injury would be associated with lower trauma death rates.
  
  
  BACKGROUND
  When viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the United States than any disease. Allocation of health care manpower to treat injuries seems logical, but studies have not been done to determine its efficacy. The effect of medical manpower and hospital resource allocation on the outcome of injury in the United States has not been fully explored or adequately evaluated.
  
  
  METHODS
  Data on trauma deaths in the United States were obtained from the National Center for Health Statistics. Data on the number of surgeons and emergency medicine physicians were obtained from the American Hospital Association and the American Medical Association. Data on physicians who have participated in the American College of Surgeons (ACS) Advanced Trauma Life Support Course (ATLS) were obtained from the ACS. Membership information for the American Association for Surgery of Trauma (AAST) was obtained from that organization. Demographic data were obtained from the United States Census Bureau. Multivariate stepwise linear regression and cluster analysis were used to model the county trauma death rates in the United States. The Statistical Analysis System (Cary, NC) for statistical analysis was used.
  
  
  RESULTS
  Bivariate and multivariate analyses showed that a variety of medical manpower measures and demographic factors were associated with county trauma death rates in the United States. As in other studies, measures of low population density and high levels of poverty were found to be strongly associated with increased trauma death rates. After accounting for these variables, using multivariate analysis and cluster analysis, an increase in the following medical manpower measures were associated with decreased county trauma death rates: number of board-certified general surgeons, number of board-certified emergency medicine physicians, number of AAST members, and number of ATLS-trained physicians.
  
  
  CONCLUSIONS
  This study confirms previous work that showed a strong relation among measures of poverty, rural setting, and increased county trauma death rates. It also found that counties with more board-certified surgeons per capita and with more surgeons with an increased interest (AAST membership) or increased training (ATLS) in trauma care have lower per-capita trauma death rates.(ABSTRACT TRUNCATED AT 400 WORDS)
authors.affiliation: Department of Surgery, University of North Carolina School of Medicine, Chapel Hill.
authors.forename: R
authors.initials: R
authors.lastname: Rutledge
authors.forename: S M
authors.initials: SM
authors.lastname: Fakhry
authors.forename: C C
authors.initials: CC
authors.lastname: Baker
authors.forename: N
authors.initials: N
authors.lastname: Weaver
authors.forename: M
authors.initials: M
authors.lastname: Ramenofsky
authors.forename: G F
authors.initials: GF
authors.lastname: Sheldon
authors.forename: A A
authors.initials: AA
authors.lastname: Meyer
mesh_terms: D001741:Black or African American; D004635:Emergency Medicine; D004651:Employment; D013502:General Surgery; D006766:Hospitals, County; D006801:Humans; D008020:Life Support Care; D008505:Medical Staff, Hospital / Q000600:supply & distribution; D010820:Physicians / Q000600:supply & distribution*; D011203:Poverty; D012423:Rural Health; D014194:Traumatology; D014481:United States / Q000453:epidemiology; D000078329:Workforce; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy