There are five different levels of trauma centres in the United States, but they can vary from state to state and not all states recognise all five levels. On 16 March 1966, Freeark established the first civilian shock trauma unit at Cook County Hospital in Chicago, Illinois. The fundamental principle underlying regional trauma systems is that concentrating patients with more severe injuries in a limited number of specialised care centres (i.e., Level I or II trauma centres) will increase patient volume and expertise at these centres and therefore improve patient outcomes. Many hospitals have their state, regional and internal guidelines that require patient data to be entered even earlier.
To be an American College of Surgeons verified trauma centre, hospitals must have 80% or more of trauma patients entered into the registry within 60 days of discharge. In addition to having implications for volume performance criteria, variations in the number and density of trauma centres can have significant cost implications associated with unnecessary duplication of costly resources. Most states have legislation that determines the designation process for trauma centres within that state. Quantitative localisation techniques hold promise for optimising trauma centre resource allocation and should be considered in the development of sound trauma system policy, which will ultimately save lives and reduce costs.
Hospital characteristics were compared between trauma centre levels and between hospitals with and without trauma centres. In the United States, a hospital can receive trauma centre status if it meets specific criteria established by the American College of Surgeons (ACS) and passes a site review by the Verification Review Committee. In a comparison of 18 states for which patient-level hospital discharge data were available, the annual number of major trauma patients treated at Level I and II trauma centres ranged from 348 in the state with the fewest Level I and II centres to 52 in the state with the most. They can provide surgical and intensive care services, as defined in the scope of trauma care services of the service.
In addition, verification of trauma centres is a voluntary process conducted by the American College of Surgeons (ACS) to evaluate and improve trauma care and covers a centre for three years. Several states have classified all hospitals with emergency departments at some level of trauma care, while others have designated a limited number of Level I and Level II facilities only. A Level III centre has transfer agreements with Level I or II trauma centres that provide support resources for the care of patients with exceptionally severe injuries (such as multiple trauma). The distribution of trauma centres by regions of the country and by rural areas is similar to the distribution of hospitals that are not trauma centres (Table.
The American College of Surgeons oversees the verification of hospitals meeting Level I, II or III trauma centre requirements and the full requirements document is 30 pages long, but the key differences are summarised in the table below.