Geographic distribution of severely injured patients: implications for trauma system development.
BACKGROUND
Despite decades of trauma system development, many severely injured patients fail to reach a trauma center for definitive care. The purpose of this study was to define the regions served by Florida's designated trauma centers and define the geographic distribution of severely injured patients who do not access the state's trauma system.


METHODS
Severely injured patients discharged from Florida hospitals were identified using the 2009 Florida Agency for Health Care Administration database. The home zip codes of patients discharged from trauma and nontrauma center hospitals were used as a surrogate for injury location and plotted on a map. A radial distance containing 75% of trauma center discharges defined trauma center catchment area.


RESULTS
Only 52% of severely injured patients were discharged from trauma centers. The catchment areas varied from 204 square miles to 12,682 square miles and together encompassed 92% state's area. Although 93% of patients lived within a trauma center catchment area, the proportion treated at a trauma center in each catchment area varied from 13% to 58%. Mapping of patient residences identified regions of limited access to the trauma system despite proximity to trauma centers.


CONCLUSIONS
The distribution of severely injured patients who do not reach trauma centers presents an opportunity for trauma system improvement. Those in proximity to trauma centers may benefit from improved and secondary triage guidelines and interfacility transfer agreements, whereas those distant from trauma centers may suggest a need for additional trauma system resources.


METHODS
Epidemiologic study, level III.
Department of Surgery, University of South Florida College of Medicine, Tampa, FL 33606, USA. dciesla@health.usf.edu
David J
DJ
Ciesla
Etienne E
EE
Pracht
John Y
JY
Cha
Barbara
B
Langland-Orban
D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005431:Florida; D005843:Geography; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D020380:Needs Assessment; D009936:Organizational Innovation; D010351:Patient Discharge / Q000706:statistics & numerical data; D016730:Program Development; D015397:Program Evaluation; D012041:Regional Medical Programs / Q000458:organization & administration; D017749:Total Quality Management; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*