Is there an increase in mortality rate associated with each additional mile from a Trauma Center (TC)?

Impact of Distance from Trauma Centers on Mortality Rates

Research demonstrates that mortality increases with every additional mile from a trauma center, with a 2% increase in mortality for each additional minute in pre-hospital response time for penetrating trauma patients. 1

Evidence on Distance and Mortality in Trauma Care

The relationship between distance to trauma centers and patient outcomes is well-established in trauma care guidelines:

• The European guideline on management of major bleeding and coagulopathy following trauma (2023) emphasizes that time elapsed between injury and bleeding control is critical for survival 1
• A study in penetrating trauma showed that every additional minute in pre-hospital response time correlated with a 2% increase in mortality, and every additional minute in pre-hospital scene time correlated with a 1% increase in mortality 1
• Rapid transportation of hemodynamically unstable patients with penetrating injuries has been shown to be particularly beneficial 1

Trauma System Organization Impact

Trauma systems with designated trauma centers have demonstrated significant improvements in patient outcomes:

• A systematic review and meta-analysis of 52 studies including over 1.1 million trauma patients showed significant reduction in mortality after implementation of trauma systems 1
• Level I trauma centers show significantly lower standardized mortality rates among bleeding trauma patients compared with level III and IV trauma centers 1
• "Systemised" trauma care that matches each patient to the most appropriate treatment facility in a timely manner is advantageous for survival 1

Transport Considerations

The mode and timing of transport significantly impact trauma outcomes:

• For patients within moderate distances (15-45 minutes) of a trauma center, rapid ground transport has shown lower mortality rates compared to helicopter transport when there would be delays in helicopter response 2
• Patients with major trauma taken directly to trauma centers had shorter hospital stays, shorter ICU stays, and lower mortality compared to those transferred from other hospitals 3
• Regional trauma centers exhibit considerably lower mortality than area trauma centers or non-centers for adult patients meeting specific physiologic triage criteria 4

Clinical Implications and Recommendations

Based on the evidence, healthcare systems should:

• Minimize the time elapsed between injury and bleeding control 1
• Transport severely injured patients directly to appropriate trauma facilities 1
• Consider the Diamond of Death concept (hypocalcemia with the traditional lethal triad of acidosis, coagulopathy, and hypothermia) in trauma resuscitation 5
• Implement trauma-specific clinical processes of care, as every 10% increase in compliance is associated with a 14% reduction in risk-adjusted in-hospital mortality 6

Pitfalls to Avoid

• Delaying transport to trauma centers for patients meeting physiologic triage criteria
• Underestimating the impact of transport time on mortality, especially in penetrating trauma
• Failing to consider the appropriate level of trauma center based on injury severity and mechanism
• Prolonged scene times, which are associated with greater mortality for both blunt and penetrating trauma 1

The evidence clearly supports regionalized trauma systems with designated trauma centers and emphasizes the critical importance of minimizing transport time to appropriate facilities to reduce mortality in trauma patients.