The impact of a new trauma center on an existing nearby trauma center.
BACKGROUND
New York State's Trauma System has been in place since 1990. At it's inception, 36 trauma centers were designated by the state. As of 2002 there were 50, with more centers applying for designation. The state designation process looks at various criteria that include volume and manpower standards. There is no review of the impact of a new center on neighboring centers. This impact can include issues of residency training, research, and the maintenance of provider skills. If provider skills deteriorate, there is a risk for increased mortality. This study examines how a new trauma center, in the Bronx, impacted a near-by trauma center.


METHODS
Data were collected from the trauma and operating room registries during the 12-month period before and after the designation of a near-by trauma center. Data included number of trauma admissions, Injury Severity Score (ISS), mechanism of injury, mortality, number of laparotomies and thoracotomies, and the type of ambulance used for transport (private vs. municipal).


RESULTS
There was a 30% reduction in "major" trauma admissions (ISS >8) and a 14% reduction in admissions with an ISS >15. This reduction included a 22% to 29% reduction in the numbers of severe head injury patients, laparotomies, and thoracotomies. Mortality rates for patients with ISS 16 to 24 and >24 increased after the designation.


CONCLUSIONS
The addition of a new trauma center in the Bronx had a negative impact on a near-by trauma center. Significant reductions in the volume of severely injured patients had a negative impact on factors not routinely measured like resident education, staff competency, and research. It is possible that these factors are at least partially responsible for the increased mortality rates seen after designation. These considerations are not routinely considered during the designation of new trauma centers and may actually adversely affect the very population it is trying to serve. As trauma systems mature, consideration of the impact the new center will have on the existing centers must be included in the designation process.
Simon
Ronald
R
NYU Medical Center, Bellevue Hospital Center, New York, New York 10016, USA. traumamd@nyc.rr.com
Stone
Melvin
M
Cucuzzo
Janet
J
D002983:Clinical Competence; D006752:Hospital Planning / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000706:statistics & numerical data; D009518:New York; D012041:Regional Medical Programs / Q000458:organization & administration*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000706:statistics & numerical data; D014187:Transportation of Patients / Q000458:organization & administration*; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy