Designated and non-designated trauma centers and trauma patients: a retrospective analysis of non-fatal trauma discharges in Georgia, 2021

Directing trauma patients to Designated Trauma Centers (DTCs) for treatment of trauma injury is vital to ensure patients’ access to quality trauma care. We study injury severity and distance to DTCs as major factors associated with care and discharge of trauma patients. We conducted a retrospective cross-sectional study using 2021 de-identified non-fatal hospital discharge data from Georgia, identifying 225,389 unique adult trauma patients with single discharge records. The outcome was the discharging hospital’s trauma designation. Predictors included whether the nearest hospital was DTC, road network distance to the nearest DTC, and the International Classification of Diseases-based Injury Severity Score (ICISS). Logistic regression with backward stepwise selection identified predictors of DTC vs. Non-designated Trauma Center (NTC) discharge, adjusting for sociodemographic, health, and injury characteristics. Patients discharged from DTCs (N = 107,743) had more severe injuries (ICISS ≤ 0.85: 1.6% vs. 0.3%) compared to NTC discharges (N = 117,646) and lived in zipcodes where the nearest hospital was a DTC (41.3% vs. 11.5%). The predicted probability of discharge from DTC exceeded 0.77 irrespective of travel time when the nearest hospital was a DTC. However, when the nearest hospital was not DTC, the probability of discharge from DTC decreased as travel time to the nearest DTC increased, i.e., from 0.735 (95%CI: 0.689, 0.782) for < 12.5 min to 0.16 (95%CI: 0.128, 0.192) for > 38.8 min. This decrease was more pronounced for less-severe patients. A lower probability of discharge from a DTC corresponds to a higher probability of discharge from an NTC. When the nearest hospital was not DTC, the likelihood of NTC discharge increased with longer travel times to the nearest DTC. In Georgia, NTCs play a crucial role in the statewide trauma system by providing care to seriously injured patients when DTCs are geographically distant. These findings underscore the importance of NTCs in ensuring timely and accessible trauma care, particularly in regions where DTCs are not readily accessible.