A POPULATION-BASED STUDY OF THE ASSOCIATION OF MEDICAL MANPOWER WITH COUNTY TRAUMA DEATH RATES IN THE UNITED-STATES

Objective To determine the association between measures of medical man power available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availab ility of medical manpower to treat trauma injury would be associated w ith lower trauma death rates. Summary Background Data When viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the Unit ed States than any disease. Allocation of health care manpower to trea t injuries seems logical, but studies have not been done to determine its efficacy. The effect of medical manpower and hospital resource all ocation on the outcome of injury in the United States has not been ful ly explored or adequately evaluated. Methods Data on trauma deaths in the United States were obtained from the National Center for Health St atistics. Data on the number of surgeons and emergency medicine physic ians were obtained from the American Hospital Association and the Amer ican Medical Association, Data on physicians who have participated in the American College of Surgeons (ACS) Advanced Trauma life Support Co urse (ATLS) were obtained from the ACS. Membership information for the American Association for Surgery of Trauma (AAST) was obtained from t hat organization. Demographic data were obtained from the United Stale s Census Bureau. Multivariate stepwise linear regression and cluster a nalysis were used to model the county trauma death rates in the United States. The Statistical Analysis System (Cary, NC) for statistical an alysis was used. Results Bivariate and multivariate analyses showed th at a variety of medical manpower measures and demographic factors were associated with county trauma death rates in the United States, As in other studies, measures of low population density and high levels of poverty were found to be strongly associated with increased trauma dea th rates. After accounting for these variables, using multivariate ana lysis and cluster analysis, an increase in the following medical manpo wer measures were associated with decreased county trauma death rates: number of board-certified general surgeons, number of board-certified emergency medicine physicians, number of AAST members, and number of ATLS-trained physicians. Conclusions This study confirms previous work that showed a strong relation among measures of poverty, rural settin g, and increased county trauma death rates. It also found that countie s with more board-certified surgeons per capita and with more surgeons with an increased interest (AAST membership) or increased training (A TLS) in trauma care have lower per-capita trauma death rates. These fi ndings are consistent with the hypothesis that physicians with increas ed interest and training in trauma care decrease the devastating toll of injury in the United States.