Unregulated proliferation of trauma centers undermines cost efficiency of population-based injury control

BACKGROUND: We evaluated the impact on coverage and regional cost of trauma care produced by the activation of a Level II center with no preceding needs analysis in an established trauma region with a Level I center. METHODS: Patient deidentified trauma registry data for years 2010, 2011, and 2012 were analyzed to assess the effect on trauma service volume during a period at the midpoint of which the Level II center was activated. Trends for each year were evaluated by patient volume, mechanism, resource use as reflected in a transfer to the intensive care unit (ICU) and ICU stay, patient severity as defined by Injury Severity Score (ISS), and patient injury profile determined by mean body region Abbreviated Injury Scale (AIS) score. RESULTS: Between 2010 and 2011, during which the Level II opened, overall volume at the Level I center dropped by 3.7%, and blunt volume remained unchanged. From 2011 to 2012, overall Level I volume dropped by 9.4%, and blunt injury fell by 14%. Proportions requiring immediate operating room or ICU care did not change. ISS distribution at the Level I center across the years was similar. Head, chest, and abdominal injuries, as assessed by AIS body region, increased slightly in severity and decreased in volume by 25%, 17%, and 18%, respectively. For 2012, the new center publically reported treating 1,100 patients, which, in concert with the Level I decrease, translates to increasing regional trauma center access by 25% while increasing expense of necessary core personnel by 217%. CONCLUSION: Addition of a second trauma center in a stable region, in which injury incidence was actually decreasing, doubled the cost of personnel, one of the most expensive components of the trauma system and decreased the volume of injuries necessary for training and education. Trauma system expansion must be based on needs assessment, which assures system survival and controls societal cost. LEVEL OF EVIDENCE: Economic & value-based evaluation, level III.