OTA 2005 Posters
Scientific Poster #17 Polytrauma/Injury Prevention
All Level I Trauma Centers are Not Created Equal: National Survey of Provided Services
Introduction: This study examines the variation in services provided among level I trauma centers across the US. Accreditation is a voluntary process with few binding requirements for status and is overseen by the American College of Surgeons (ACS) and/or state or county government. As such, there may be significant variation in the amount and nature of resources, provider availability and training, and overall infrastructure between level I trauma centers.
Methods: A three-page questionnaire was administered to trauma coordinators at 126 level I centers in 37 states, which were identified by the ACS and Bishop and Associates. We queried variances in trauma, neurosurgery, plastics, and orthopaedic surgery with regard to number and training of participating physicians, dedicated OR support (rooms and staff), on-call pay, and research. Statistical analysis was completed using SPSS Software.
Results: Of the 136 centers surveyed, 39% did not have ACS accreditation. Those without ACS certification were identified as level I trauma facilities by state, county, or district level government. Ninety of the centers (66%) are university-based facilities and employ more surgeons and ancillary staffing across trauma and all subspecialties. Nearly 90% of the centers surveyed have active trauma research programs; however, 50% of level I centers do not provide on-call pay to their trauma surgeons. 91% of university-affiliated centers provide in-house orthopaedic trauma services 24/7, compared to only 63% of community-based centers and 60% of public centers, respectively. 58% of the all centers queried fail to provide on-call pay for their orthopaedic trauma surgeons; 70% do not provide dedicated orthopaedic trauma staffing; 71% lack a dedicated orthopaedic OR; 33% do not employ fellowship-trained orthopaedic surgeons; and 35% do not have active research programs. 86% of university-affiliated centers provide in-house neurosurgery services 24/7, compared to only 53% of community-based centers and 50% of public centers, respectively. 59% of centers do not provide on-call pay for their neurosurgeons; 70% do not provide dedicated neurosurgery staffing; 73% lack a dedicated neurosurgical OR; and 33% do not have active research departments. 69% of university-affiliated centers provide in-house plastic surgery services 24/7, compared to only 50% of community-based centers and 50% of public centers, respectively. 76% of centers do not provide on-call pay for their plastic surgeons; 86% do not provide dedicated plastic surgery staffing; 85% lack a dedicated plastic surgery OR; 40% do employ fellowship-trained plastic surgeons; and 65% do not have active research programs.
Discussion: We found that many trauma centers are not ACS-accredited and that there are definite variances of services provided, especially between academic and community/public centers. Academic facilities seem to provide more in-house coverage of vital trauma services. Considering that so many trauma patients have orthopaedic injuries, the lack of in-house orthopaedic support (especially in nonuniversity centers), the availability of fellowship-trained orthopaedic traumatologists, and the presence of dedicated ancillary staffing and operating rooms are all of concern. While implying variance in delivered care, such resource differentials may ultimately impact the efficacy and cost-effectiveness of treatment. In particular, most centers are significantly lacking in structured and dedicated orthopaedic services as recommended by the OTA. Considering the frequency and complexity of orthopaedic trauma, it is surprising that more committed logistical support does not exist.