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Author Notes:

Correspondence to Dr Dennis W Ashley, Department of Surgery, The Medical Center, Navicent Health, Macon, Georgia 31201, USA; ashley.dennis@navicenthealth.org

Contributors: DWA and EEP participated in study design, data collection, analysis and interpretation of data, drafting of the article, and critical revision. LEG, RSM, EVA, and TJJ participated in the analysis and interpretation of data and critical revision. CHF, JRD, and JMN participated in critical revision.

Acknowledgements: We thank Dr J Patrick O’Neal, Commissioner, Department of Public Health, the Office of Emergency Medical Services and Trauma, the Georgia Hospital Association, and the Georgia Trauma Care Network Commission for their dedication to trauma care in Georgia. Special thanks to Virginia Land for assisting with the preparation of this article.

Competing interests: None declared.


Research Funding:

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.


  • assessment tool
  • trauma systems

Evaluation of the Georgia trauma system using the American College of surgeons needs based assessment of trauma systems tool


Journal Title:

Trauma Surgery and Acute Care Open


Volume 3, Number 1


, Pages e000188-e000188

Type of Work:

Article | Final Publisher PDF


Background: The American College of Surgeons Needs Based Assessment of Trauma Systems (NBATS) tool was developed to help determine the optimal regional distribution of designated trauma centers (DTC). The objectives of our current study were to compare the current distribution of DTCs in Georgia with the recommended allocation as calculated by the NBATS tool and to see if the NBATS tool identified similar areas of need as defined by our previous analysis using the International Classification of Diseases, Ninth Revision, Clinical Modification Injury Severity Score (ICISS). Methods Population counts were acquired from US Census publications. Transportation times were estimated using digitized roadmaps and patient zip codes. The number of severely injured patients was obtained from the Georgia Discharge Data System for 2010 to 2014. Severely injured patients were identified using two measures: ICISS<0.85 and Injury Severity Score >15. results The Georgia trauma system includes 19 level I, II, or III adult DTCs. The NBATS guidelines recommend 21; however, the distribution differs from what exists in the state. The existing DTCs exactly matched the NBATS recommended number of level I, II, or III DTCs in 2 of 10 trauma service areas (TSAs), exceeded the number recommended in 3 of 10 TSAs, and was below the number recommended in 5 of 10 TSAs. Densely populated, or urban, areas tend to be associated with a higher number of existing centers compared with the NBATS recommendation. Other less densely populated TSAs are characterized by large rural expanses with a single urban core where a DTC is located. The identified areas of need were similar to the ones identified in the previous gap analysis of the state using the ICISS methodology. Discussion The tool appears to underestimate the number of centers needed in extensive and densely populated areas, but recommends additional centers in geographically expansive rural areas. The tool signifies a preliminary step in assessing the need for state-wide inpatient trauma center services. Level of evidence Economic, level IV.

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© Author(s) (or their employer(s)) 2018.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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