Effects of Closure of an Urban Level I Trauma Center on Adjacent Hospitals and Local Injury Mortality

Background/Purpose: Martin Luther King Hospital (MLK), the principal Level I trauma center to South Los Angeles, began closure in 2004 due inability to comply with federal standards for health and safety. Our objective was to assess the effects of the closure of MLK on the distribution of admissions and injury mortality rates on adjacent trauma centers during and after the three year closure period. Methods: Deidentified and partially masked, public use, patient-level data was obtained for all patients who were admitted to acute, non-federal hospitals from 1999-2009. Data included age, gender, race, insurance status, visit year, and ICD-9 codes for diagnoses. Geospatial analysis, bivariate analysis of demographic data, and multivariate regression comparing observed to expected (O/E) mortality rates were performed. Outcome measures were admissions to the four surrounding South Los Angeles hospitals within a 10 mile radius of MLK (TC1-4) and mortality rates for the four most common traumatic injury mechanisms: gunshot wounds (GSWs), stab wounds, falls, and motor vehicle collisions. Results: During the study period, trauma admissions increased significantly at nearby hospitals. Though crude mortality rates increased markedly for TCs 1-3 during the transition period, O/E analysis identified only one year, 2005, in which the observed mortality rate exceeded the expected range (TC3, OR 1.36, 95% CI 1.06-1.66). Conclusions: During and after the closure of MLK, nearby trauma centers experienced a dramatic increase in trauma patient volumes, particularly for gunshot wounds. This resulted in transient but significant increased injury mortality for local trauma patients in at least one hospital.