TY - JOUR
T1 - Distance matters
T2 - Effect of geographic trauma system resource organization on fatal motor vehicle collisions
AU - Brown, Joshua B.
AU - Rosengart, Matthew R.
AU - Billiar, Timothy R.
AU - Peitzman, Andrew B.
AU - Sperry, Jason L.
N1 - Funding Information:
No funding or support was directly received to perform the current study. J.B.B. receives support from an institutional T32 Ruth L. Kischstein National Research Service Award training grant (5T32GM008516-20) from the National Institutes of Health.
Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - BACKGROUND Trauma systems improve outcome; however, it is unclear how geographic organization of trauma system resources (TSR) affects outcome. Our objective was to evaluate the relationship of fatal motor vehicle collision (MVC) rates and the distance from individual MVC locations to the nearest TSR as a measure of the geographical organization of trauma systems, as well as how theoretical changes in the distribution of TSR may affect fatal MVC rates. METHODS All fatal MVC in Pennsylvania 2013-2014 were mapped from the Fatality Analysis Reporting System database. Deaths on scene were excluded. TSR including trauma centers and helicopter bases were mapped. Distance between each fatal MVC and nearest TSR was calculated. The primary outcome was fatal MVC rate per 100 million vehicle miles traveled (VMT). Empiric Bayes kriging and hot spot analysis were performed to evaluate geographic patterns in fatal MVC rates. Association between fatal MVC rate and distance to the nearest TSR was evaluated with linear regression. Spatial lag regression evaluated this association while controlling for MVC and county-level characteristics. RESULTS We identified 886 fatalities from 863 fatal MVC. Median fatal MVC rate was 0.187 per 100 million VMT. Higher fatal MVC rates and fatality hot spots occur in locations farther from TSR. The fatal MVC rate increased 0.141 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). When controlling for confounders, the fatal MVC rate increased by 0.089 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). If two helicopters stationed at trauma centers were relocated into the highest fatality regions, our model predicts a 12.3% relative reduction in the overall MVC fatality rate. CONCLUSIONS Increasing distance to the nearest TSR is associated with increasing fatal MVC rate. The geographic organization of trauma systems may impact outcome, and geospatial analysis can allow data-driven changes to potentially improve outcome. LEVEL OF EVIDENCE Prognostic/Epidemiologic, level III; Case management, level III.
AB - BACKGROUND Trauma systems improve outcome; however, it is unclear how geographic organization of trauma system resources (TSR) affects outcome. Our objective was to evaluate the relationship of fatal motor vehicle collision (MVC) rates and the distance from individual MVC locations to the nearest TSR as a measure of the geographical organization of trauma systems, as well as how theoretical changes in the distribution of TSR may affect fatal MVC rates. METHODS All fatal MVC in Pennsylvania 2013-2014 were mapped from the Fatality Analysis Reporting System database. Deaths on scene were excluded. TSR including trauma centers and helicopter bases were mapped. Distance between each fatal MVC and nearest TSR was calculated. The primary outcome was fatal MVC rate per 100 million vehicle miles traveled (VMT). Empiric Bayes kriging and hot spot analysis were performed to evaluate geographic patterns in fatal MVC rates. Association between fatal MVC rate and distance to the nearest TSR was evaluated with linear regression. Spatial lag regression evaluated this association while controlling for MVC and county-level characteristics. RESULTS We identified 886 fatalities from 863 fatal MVC. Median fatal MVC rate was 0.187 per 100 million VMT. Higher fatal MVC rates and fatality hot spots occur in locations farther from TSR. The fatal MVC rate increased 0.141 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). When controlling for confounders, the fatal MVC rate increased by 0.089 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). If two helicopters stationed at trauma centers were relocated into the highest fatality regions, our model predicts a 12.3% relative reduction in the overall MVC fatality rate. CONCLUSIONS Increasing distance to the nearest TSR is associated with increasing fatal MVC rate. The geographic organization of trauma systems may impact outcome, and geospatial analysis can allow data-driven changes to potentially improve outcome. LEVEL OF EVIDENCE Prognostic/Epidemiologic, level III; Case management, level III.
KW - Geographic information systems
KW - helicopter
KW - motor vehicle collision
KW - outcomes
KW - trauma center
UR - http://www.scopus.com/inward/record.url?scp=85017617978&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000001508
DO - 10.1097/TA.0000000000001508
M3 - Article
C2 - 28422905
AN - SCOPUS:85017617978
SN - 2163-0755
VL - 83
SP - 111
EP - 118
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -