Distance matters: Effect of geographic trauma system resource organization on fatal motor vehicle collisions.

Background: Trauma systems improve outcome; however, it is unclear how geographic organization of trauma system resources (TSR) affects outcome. Our objective was to evaluate the relationship of fatal motor vehicle collisions (MVC) rates and the distance from individual MVC locations to the nearest TSR as a measure of the geographical organization of trauma systems, as well as how theoretical changes in the distribution of TSR may affect fatal MVC rates. Methods: All fatal MVC in Pennsylvania 2013-14 were mapped from the FARS database. Deaths on scene were excluded. TSR including trauma centers and helicopter bases were mapped. Distance between each fatal MVC and nearest TSR was calculated. The primary outcome was fatal MVC rate per 100million vehicle miles traveled (VMT). Empiric Bayes Kriging and hotspot analysis were performed to evaluate geographic patterns in fatal MVC rates. Association between fatal MVC rate and distance to the nearest TSR was evaluated with linear regression. Spatial lag regression evaluated this association while controlling for MVC and county-level characteristics. Results: We identified 886 fatalities from 863 fatal MVC. Median fatal MVC rate was 0.187 per 100million VMT. Higher fatal MVC rates and fatality hotspots occur in locations farther from TSR. The fatal MVC rate increased 0.141 per 100million VMT for every 10 miles farther from the nearest TSR (p

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