title: Understanding an inclusive trauma system through characterization of admissions at level IV centers.
abstract: BACKGROUND
  Level IV trauma centers are an integral part of inclusive trauma systems, although sparse data exists for these facilities.
  
  
  METHODS
  An observational study was conducted using a Midwestern state's inpatient data files to characterize level IV center patients. Injury and severity levels, injury mechanism and/or intent, and distances to nearest tertiary centers were determined.
  
  
  RESULTS
  During the study year, 3,346 injured patients were admitted at level IV centers. The median distance to nearest tertiary center was 43 miles. Median patient age was 81 years, and primary injury mechanism was falls. Overall, 22% of patients had an isolated hip fracture. Of moderately injured patients, 64% had an isolated hip fracture, 8% nonisolated hip fractures, and 9% rib fractures without hip fracture. Overall, 30% of patients had a high severity of injury.
  
  
  CONCLUSIONS
  A large number of patients were admitted to level IV trauma centers. Patients admitted tended to be elderly and have orthopedic fall injuries. Study results provide important implications for provider education, prevention efforts, need for orthopedic surgical capabilities, and necessity of capturing these data in registries.
authors.affiliation: Iowa Methodist Medical Center, General Surgery Residency Program, 1415 Woodland Avenue, Suite 140, Des Moines, IA 50309-1453, USA; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Hayden L
authors.initials: HL
authors.lastname: Smith
authors.affiliation: Iowa Methodist Medical Center, General Surgery Residency Program, 1415 Woodland Avenue, Suite 140, Des Moines, IA 50309-1453, USA.
authors.forename: H
authors.initials: H
authors.lastname: Clay Dean
authors.affiliation: Iowa Methodist Medical Center, General Surgery Residency Program, 1415 Woodland Avenue, Suite 140, Des Moines, IA 50309-1453, USA. Electronic address: Richard.Sidwell@unitypoint.org.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Sidwell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007484:Iowa / Q000453:epidemiology; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
keywords: Aged; Hip fractures; Injuries; Registries; Trauma centers; Traumatic brain injury