States with poor access to trauma centers have more prehospital deaths

States that have poor access to a comprehensive trauma center see more deaths before an injured patient's arrival at a hospital compared to states that have better access to these facilities, according to research findings presented at the American College of Surgeons clinical congress.

The frequency of prehospital deaths contributes to higher overall trauma-related mortality, and 28 states have an above-average prehospital death burden, reported researchers from Boston-based Brigham and Women's Hospital.

The reasons 28 states have higher prehospital death rates are not known but likely varied, said Zain Hashmi, MD, who helped conduct the study.

The researchers looked at 1.95 million trauma deaths in U.S. adults (ages 15 and older) reported to the CDC between 1999 and 2016. They then compared the frequency of deaths occurring in-hospital with those happening before patients arrived at the hospital.

Overall, the largest percentage of trauma deaths occurred before hospital arrival (49 percent), compared with 42 percent of in-hospital deaths, the study found.

The researchers suggest states with a high prehospital death burden improve care access by shortening patient transport times, optimizing trauma center placement and improving prehospital care quality.

"We know faster transportation time to a trauma center saves lives, but we didn't know about the regional differences in trauma center access," Dr. Hashmi said. "Despite a major decline in in-hospital mortality for high-risk trauma since 1970, there has been little emphasis at the national level on improving the prehospital death rate due to trauma."

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