|
 States like Maine, Pennsylvania, Massachusetts, Michigan and North
Dakota had the highest density of surgical critical care (SCC)
providers, while Alaska, Georgia, Oklahoma and New Mexico had the
lowest density, based on 2013 data.
“We already know that healthcare resources are inequitably
distributed across the United States,” said coauthor David Metcalfe,
a Clinical Research Fellow in Musculoskeletal Trauma at the
University of Oxford in the United Kingdom.
The number of injured patients is related to the number of people
living in a given area, and some populations, such as young males,
are particularly likely to be injured, he said.
The researchers used several sources to obtain state-level data on
trauma admissions, trauma centers and SCC providers, SCC fellowship
positions to train doctors, per-capita income, population size and
mortality rates for 2013.
Overall, they found there were just over 1.3 million trauma
admissions, 2,496 SCC providers and 1,987 trauma centers across the
country, including 521 Level I or II trauma centers.
Trauma centers are designated levels I through V based on the kinds
of resources available there. Level I centers can provide total care
for every aspect of injury while Level V centers have basic
emergency department facilities and can prepare patients to be
transferred to higher levels of care.
Level I and II centers were more often located in the Mid Atlantic
and South Atlantic regions and in larger cities, according to the
results in the Journal of the American College of Surgeons.
Trauma admission density – the number of admissions per million
population - was highest in West Virginia, Missouri and Florida, and
lowest in North Carolina, Texas and Illinois. While the admissions
density ratio between highest- and lowest- density states was about
1.5 to 1, the ratio of availability of SCC providers and of SCC
fellowships was 8 to 1.
The study also found that when density of SCC providers went up,
mortality rates went down. For each additional SCC provider per
million population, there was a decrease of 618 deaths per year.
“Unfortunately, this study suggests that trauma services are not
always located where the ‘need’ is greatest,” Metcalfe said.
“Trauma centers are not established and maintained based on need,”
said Dr. Edward Kelly of Brigham and Women's Hospital in Boston,
Massachusetts, who was not part of the new study.
[to top of second column] |
Cities that have a lot of other resources also have trauma services,
like New York, Boston and the Bay area, which are also hubs for
other jobs in Silicon Valley, finance and advertising, Kelly told
Reuters Health by phone.
“The trauma training programs are in places that can afford to train
people,” he said.
“There are lots of reasons why trauma services might be inequitably
distributed,” Metcalfe told Reuters Health by email. “These include
whether local hospitals have the resources that are necessary to
achieve trauma center accreditation, whether or not local trauma
services are profitable, and difficulties recruiting trauma
specialists to some areas.”
Trauma survival and recovery depends largely on the speed at which
patients reach specialist treatment, he said.
While in general more trauma centers mean better patient outcomes,
“some markets are saturated, and others are underserved,” Kelly
said. As of right now there’s no agency body or person with the
authority to force regions to establish or develop trauma centers,
he said.
“Although it is great to have lots of trauma centers and
specialists, this can actually be sub-optimal if that means each
hospital only treats a small number of critically injured patients,”
Metcalfe said. “This is because hospitals and individual specialists
risk losing their expertise if they only treat a small number of
patients each year.”
SOURCE: http://bit.ly/2fz166Y Journal of the American College of
Surgeons, online October 27, 2016.
[© 2016 Thomson Reuters. All rights
reserved.] Copyright 2016 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
