J. J. Sumislawski1, S. A. Savage1, B. L. Zarzaur2 1University Of Tennessee Health Science Center,Memphis, TN, USA 2Indiana University School Of Medicine,Indianapolis, IN, USA
Introduction: Organization of trauma centers into a state trauma system is associated with reduced mortality. Development of a trauma system could affect a neighboring state’s trauma center. In 2010, an inclusive trauma system was implemented that allowed centers in bordering states to participate. This study was designed to examine the effect of the development of this new trauma system on a participating out-of-state Level 1 trauma center.
Methods: Patients referred to a participating out-of-state trauma center were included. Using a difference-in-differences approach, residents of the state with the new trauma system (TSystem patients) were compared with residents of the state with the trauma center (TCenter patients) PRE (2008-2009) and POST (2011-2012) implementation of the trauma system.
Results: TCenter patients decreased 3% PRE versus POST while TSystem patients increased 39% (Table 1). Injury severity did not change for TCenter patients but decreased for TSystem patients PRE (mean Injury Severity Score 15) versus POST (12, p<0.05). Transfers from referring hospitals increased from both states. For TSystem patients, air arrivals decreased and payer status did not change. Compared with TCenter patients, odds of mortality for TSystem patients decreased PRE (OR 0.97; 95% CI 0.72, 1.31) versus POST (OR 0.73; 95% CI 0.53, 0.99). When only those with ISS >10 were analyzed, mortality did not change PRE (OR 0.85; 95% CI 0.60, 1.20) versus POST (OR 0.96; 95% CI 0.67, 1.37). Secondary overtriage increased PRE (OR 0.67; 95% CI 0.54, 0.83) versus POST (OR 1.53; 95% CI 1.32, 1.78) for TSystem patients.
Conclusion: Development of a state trauma system resulted in an increase in less severely injured patients referred to an out-of-state trauma center without change in payer status. For patients of higher injury severity, there was no change in odds of mortality PRE versus POST for either state. Trauma-system implementation promoted overtriage of in-state patients to the out-of-state trauma center. Despite increases in volume and overtriage, allowing participation of a neighboring state’s trauma center did not result in increased mortality for either state’s residents.
