Access Delayed Is Access Denied: Relationship Between Access to Trauma Center Care and Pre-Hospital Death

Zain G. Hashmi, Molly P. Jarman, Tarsicio Uribe-Leitz, Eric Goralnick, Craig Newgard, Ali Salim, Edward Cornwell, Adil H. Haider

Research output: Contribution to journalArticle

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Abstract

Background: Timely access to trauma center (TC) care is critical to achieve “Zero Preventable Deaths after Injury.” However, the impact of timely access to TC care on pre-hospital deaths in each US state remains unknown. We sought to determine the state-level relationship between the proportion of pre-hospital deaths, age-adjusted mortality, and timely access to trauma center care. Study Design: We analyzed state-level analysis of adult trauma deaths reported to the CDC Wide-ranging Online Data for Epidemiological Research (WONDER) (1999 to 2016). Correlation between the state-level pre-hospital:in-hospital death ratio (PH:IH), the proportion of population with access to Level-I/II TC, and the age-adjusted mortality rate (AAMR) was determined. Population proportion with timely access to TC care was compared between states with a high pre-hospital death burden vs all other states. National estimates of potentially preventable pre-hospital deaths were calculated. Results: There were 1,949,375 trauma deaths analyzed. Overall, 1.19 times more deaths occurred pre-hospital (49%, n = 960,554) than in-hospital (42%, n = 810,387). States with better TC access had a lower AAMR (r = −0.71, p < 0.05) and relatively fewer pre-hospital deaths (r = −0.64, p < 0.05); states with higher AAMR had relatively more pre-hospital deaths (r = 0.70, p < 0.05). States with a high pre-hospital death burden had a lower proportion of population with access to Level-I/II TC within 1 hour vs all other states (63.2% vs 90.2%, p < 0.001). If all states had the same PH:IH death ratio as those among the best quartile for access, 129,213 pre-hospital deaths may potentially have been averted. Conclusions: States with poor TC access have more pre-hospital deaths, which contribute to higher overall injury mortality. This suggests that in these states, improving TC access will be critical to achieve “Zero Preventable Deaths after Injury.”

Original languageEnglish (US)
Pages (from-to)9-20
Number of pages12
JournalJournal of the American College of Surgeons
Volume228
Issue number1
DOIs
StatePublished - Jan 1 2019

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Trauma Centers
Mortality
Wounds and Injuries
Population
Critical Care
Centers for Disease Control and Prevention (U.S.)

ASJC Scopus subject areas

  • Surgery

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Access Delayed Is Access Denied : Relationship Between Access to Trauma Center Care and Pre-Hospital Death. / Hashmi, Zain G.; Jarman, Molly P.; Uribe-Leitz, Tarsicio; Goralnick, Eric; Newgard, Craig; Salim, Ali; Cornwell, Edward; Haider, Adil H.

In: Journal of the American College of Surgeons, Vol. 228, No. 1, 01.01.2019, p. 9-20.

Research output: Contribution to journalArticle

Hashmi, Zain G. ; Jarman, Molly P. ; Uribe-Leitz, Tarsicio ; Goralnick, Eric ; Newgard, Craig ; Salim, Ali ; Cornwell, Edward ; Haider, Adil H. / Access Delayed Is Access Denied : Relationship Between Access to Trauma Center Care and Pre-Hospital Death. In: Journal of the American College of Surgeons. 2019 ; Vol. 228, No. 1. pp. 9-20.
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abstract = "Background: Timely access to trauma center (TC) care is critical to achieve “Zero Preventable Deaths after Injury.” However, the impact of timely access to TC care on pre-hospital deaths in each US state remains unknown. We sought to determine the state-level relationship between the proportion of pre-hospital deaths, age-adjusted mortality, and timely access to trauma center care. Study Design: We analyzed state-level analysis of adult trauma deaths reported to the CDC Wide-ranging Online Data for Epidemiological Research (WONDER) (1999 to 2016). Correlation between the state-level pre-hospital:in-hospital death ratio (PH:IH), the proportion of population with access to Level-I/II TC, and the age-adjusted mortality rate (AAMR) was determined. Population proportion with timely access to TC care was compared between states with a high pre-hospital death burden vs all other states. National estimates of potentially preventable pre-hospital deaths were calculated. Results: There were 1,949,375 trauma deaths analyzed. Overall, 1.19 times more deaths occurred pre-hospital (49{\%}, n = 960,554) than in-hospital (42{\%}, n = 810,387). States with better TC access had a lower AAMR (r = −0.71, p < 0.05) and relatively fewer pre-hospital deaths (r = −0.64, p < 0.05); states with higher AAMR had relatively more pre-hospital deaths (r = 0.70, p < 0.05). States with a high pre-hospital death burden had a lower proportion of population with access to Level-I/II TC within 1 hour vs all other states (63.2{\%} vs 90.2{\%}, p < 0.001). If all states had the same PH:IH death ratio as those among the best quartile for access, 129,213 pre-hospital deaths may potentially have been averted. Conclusions: States with poor TC access have more pre-hospital deaths, which contribute to higher overall injury mortality. This suggests that in these states, improving TC access will be critical to achieve “Zero Preventable Deaths after Injury.”",
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AU - Uribe-Leitz, Tarsicio

AU - Goralnick, Eric

AU - Newgard, Craig

AU - Salim, Ali

AU - Cornwell, Edward

AU - Haider, Adil H.

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N2 - Background: Timely access to trauma center (TC) care is critical to achieve “Zero Preventable Deaths after Injury.” However, the impact of timely access to TC care on pre-hospital deaths in each US state remains unknown. We sought to determine the state-level relationship between the proportion of pre-hospital deaths, age-adjusted mortality, and timely access to trauma center care. Study Design: We analyzed state-level analysis of adult trauma deaths reported to the CDC Wide-ranging Online Data for Epidemiological Research (WONDER) (1999 to 2016). Correlation between the state-level pre-hospital:in-hospital death ratio (PH:IH), the proportion of population with access to Level-I/II TC, and the age-adjusted mortality rate (AAMR) was determined. Population proportion with timely access to TC care was compared between states with a high pre-hospital death burden vs all other states. National estimates of potentially preventable pre-hospital deaths were calculated. Results: There were 1,949,375 trauma deaths analyzed. Overall, 1.19 times more deaths occurred pre-hospital (49%, n = 960,554) than in-hospital (42%, n = 810,387). States with better TC access had a lower AAMR (r = −0.71, p < 0.05) and relatively fewer pre-hospital deaths (r = −0.64, p < 0.05); states with higher AAMR had relatively more pre-hospital deaths (r = 0.70, p < 0.05). States with a high pre-hospital death burden had a lower proportion of population with access to Level-I/II TC within 1 hour vs all other states (63.2% vs 90.2%, p < 0.001). If all states had the same PH:IH death ratio as those among the best quartile for access, 129,213 pre-hospital deaths may potentially have been averted. Conclusions: States with poor TC access have more pre-hospital deaths, which contribute to higher overall injury mortality. This suggests that in these states, improving TC access will be critical to achieve “Zero Preventable Deaths after Injury.”

AB - Background: Timely access to trauma center (TC) care is critical to achieve “Zero Preventable Deaths after Injury.” However, the impact of timely access to TC care on pre-hospital deaths in each US state remains unknown. We sought to determine the state-level relationship between the proportion of pre-hospital deaths, age-adjusted mortality, and timely access to trauma center care. Study Design: We analyzed state-level analysis of adult trauma deaths reported to the CDC Wide-ranging Online Data for Epidemiological Research (WONDER) (1999 to 2016). Correlation between the state-level pre-hospital:in-hospital death ratio (PH:IH), the proportion of population with access to Level-I/II TC, and the age-adjusted mortality rate (AAMR) was determined. Population proportion with timely access to TC care was compared between states with a high pre-hospital death burden vs all other states. National estimates of potentially preventable pre-hospital deaths were calculated. Results: There were 1,949,375 trauma deaths analyzed. Overall, 1.19 times more deaths occurred pre-hospital (49%, n = 960,554) than in-hospital (42%, n = 810,387). States with better TC access had a lower AAMR (r = −0.71, p < 0.05) and relatively fewer pre-hospital deaths (r = −0.64, p < 0.05); states with higher AAMR had relatively more pre-hospital deaths (r = 0.70, p < 0.05). States with a high pre-hospital death burden had a lower proportion of population with access to Level-I/II TC within 1 hour vs all other states (63.2% vs 90.2%, p < 0.001). If all states had the same PH:IH death ratio as those among the best quartile for access, 129,213 pre-hospital deaths may potentially have been averted. Conclusions: States with poor TC access have more pre-hospital deaths, which contribute to higher overall injury mortality. This suggests that in these states, improving TC access will be critical to achieve “Zero Preventable Deaths after Injury.”

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