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Plenary paper
Describing the density of high-level trauma centers in the 15 largest US cities
  1. Anne M Stey1,
  2. Alexandria Byskosh1,
  3. Caryn Etkin1,
  4. Robert Mackersie2,
  5. Deborah M Stein3,
  6. Karl Y Bilimoria1,
  7. Marie L Crandall4
  1. 1Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Department of Surgery, University of California San Francisco, San Francisco, California, USA
  3. 3R Adams Cowley Shock Trauma Center, San Francisco, California, USA
  4. 4Department of Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
  1. Correspondence to Dr Anne M Stey, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611-3008, USA; as013j{at}gmail.com

Abstract

Background There has been a proliferation of urban high-level trauma centers. The aim of this study was to describe the density of high-level adult trauma centers in the 15 largest cities in the USA and determine whether density was correlated with urban social determinants of health and violence rates.

Methods The largest 15 US cities by population were identified. The American College of Surgeons’ (ACS) and states’ department of health websites were cross-referenced for designated high-level (levels 1 and 2) trauma centers in each city. Trauma centers and associated 20 min drive radius were mapped. High-level trauma centers per square mile and per population were calculated. The distance between high-level trauma centers was calculated. Publicly reported social determinants of health and violence data were tested for correlation with trauma center density.

Results Among the 15 largest cities, 14 cities had multiple high-level adult trauma centers. There was a median of one high-level trauma center per every 150 square kilometers with a range of one center per every 39 square kilometers in Philadelphia to one center per596 square kilometers in San Antonio. There was a median of one high-level trauma center per 285 034 people with a range of one center per 175 058 people in Columbus to one center per 870 044 people in San Francisco. The median minimum distance between high-level trauma centers in the 14 cities with multiple centers was 8 kilometers and ranged from 1 kilometer in Houston to 43 kilometers in San Antonio. Social determinants of health, specifically poverty rate and unemployment rate, were highly correlated with violence rates. However, there was no correlation between trauma center density and social determinants of health or violence rates.

Discussion High-level trauma centers density is not correlated with social determinants of health or violence rates.

Level of evidence VI.

Study type Economic/decision.

  • systems analysis
  • violence
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2020-000562

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    Footnotes

    • Presented at This work was presented at the 50th Annual Meeting of Western Trauma Association, 24–29 February 2020, Sun Valley, Idaho.

    • Contributors Study design was performed by AMS and MLC. Data collection and analysis was performed by AMS and AB. Data interpretation, writing and critical revision were performed by all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. All data are publicly available.