Fifteen-Year Trauma System Performance Analysis Demonstrates Optimal Coverage for Most Severely Injured Patients and Identifies a Vulnerable Population

Abstract

Trauma systems are designed to deliver timely and appropriate care. Prehospital triage regulations and interfacility transfer guidelines are the primary determinants of system efficacy. We analyzed the effectiveness of the Florida trauma system in delivering trauma patients to trauma centers over time. Injured patients were identified by ICD-9 codes from a statewide discharge dataset, and they were categorized as children (less than 16 years old), adult (16 to 65 years old), or elderly (over 65 years old). Severe injury was defined by International Classification Injury Severity Scores (ICISS) < 0.85. Residence ZIP codes were used as a surrogate for injury location. Severe injury discharges increased at designated trauma centers (DTCs) and decreased at nontrauma centers (NTCs). The proportion of patients with severe injuries discharged from DTCs increased for all age groups, capturing nearly all severely injured children and adults. Access to DTCs was dependent on proximity for severely injured elderly but not for severely injured children and adults. Triage improved over time, enabling near complete capture of at-risk children and adults independent of DTC proximity. Because distance from a DTC does not limit access for children and adults, existing trauma system resources are sufficient to meet the current demands. Efforts are needed to determine the trauma resource and triage needs of the severely injured elderly.