Trauma Center Closure Increases Mortality Risk

A new study reveals a strong association between closure of trauma centers and increased mortality for patients with injuries.

Researchers at the University of California, San Francisco (UCSF; USA) performed a retrospective study of all adult patient visits for injuries at Level I and II to nonfederal trauma centers in California (USA) between 1999 and 2009, to examine the impact of three trauma center closures. The researchers compared the in-hospital mortality of 5,122 patients who lived in ZIP [US postal] codes where their drive time to that nearest trauma center increased as the result of a nearby closure to 228,236 patients whose drive time did not change, and 37,787 patients whose travel time decreased as the result of a trauma center opening. They also tested whether this effect was limited to a two-year period following a closure.

The results showed that decreased travel time to the closest trauma center was associated with 17% lower odds of in-hospital mortality compared to the group experiencing no change, while increased travel time was associated with 14% higher odds of in-hospital mortality. These effects were intensified in the first two years following a closure. Injured patients with decreased travel times to the nearest trauma center had 16% lower odds of death, while injured patients affected by a closure had 26% higher odds of death. The article was published in the March 2014 issue of the Journal of Trauma and Acute Care Surgery.

“This study confirms that when trauma centers close, people who live in the surrounding areas are more likely to die following an injury,” said lead author Renee Hsia, MD, an associate professor of emergency medicine at UCSF. “Affected patients were more likely to be young and low income, to identify as part of a racial or ethnic minority group, and have medical insurance.”

Trauma centers are an effective but costly element of the US health care infrastructure. Some Level I and II trauma centers regularly incur financial losses when these high fixed costs are coupled with high burdens of uncompensated care for disproportionately young and uninsured trauma patients. As a result, they are at risk of reducing their services or closing.

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