title: Trauma deserts: distance from a trauma center, transport times, and mortality from gunshot wounds in Chicago.
abstract: OBJECTIVE
  We examined whether urban patients who suffered gunshot wounds (GSWs) farther from a trauma center would have longer transport times and higher mortality.
  
  
  METHODS
  We used the Illinois State Trauma Registry (1999-2009). Scene address data for Chicago-area GSWs was geocoded to calculate distance to the nearest trauma center and compare prehospital transport times. We used multivariate regression to calculate the effect on mortality of being shot more than 5 miles from a trauma center.
  
  
  RESULTS
  Of 11,744 GSW patients during the study period, 4782 were shot more than 5 miles from a trauma center. Mean transport time and unadjusted mortality were higher for these patients (P < .001 for both). In a multivariate model, suffering a GSW more than 5 miles from a trauma center was associated with an increased risk of death (odds ratio = 1.23; 95% confidence interval = 1.02, 1.47; P = .03).
  
  
  CONCLUSIONS
  Relative "trauma deserts" with decreased access to immediate care were found in certain areas of Chicago and adversely affected mortality from GSWs. These results may inform decisions about trauma systems planning and funding.
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. mcrandall@northwestern.edu
authors.forename: Marie
authors.initials: M
authors.lastname: Crandall
authors.forename: Douglas
authors.initials: D
authors.lastname: Sharp
authors.forename: Erin
authors.initials: E
authors.lastname: Unger
authors.forename: David
authors.initials: D
authors.lastname: Straus
authors.forename: Karen
authors.initials: K
authors.lastname: Brasel
authors.forename: Renee
authors.initials: R
authors.lastname: Hsia
authors.forename: Thomas
authors.initials: T
authors.lastname: Esposito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002641:Chicago / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012042:Registries; D012044:Regression Analysis; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data* / Q000600:supply & distribution; D014948:Wounds, Gunshot / Q000401:mortality*; D055815:Young Adult