The American College of Surgeons (ACS) Needs-Based Assessment of Trauma Systems (NBATS): Estimates for the State of California

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In 2015, the American College of Surgeons Committee on Trauma convened a consensus conference to develop the Needs Based Assessment of Trauma Systems (NBATS) tool to assist in determining the number of trauma centers (TCs) required for a region. We tested the performance of NBATS with respect to the optimal number of TCs needed by region in California.


TC data was obtained from the California Emergency Services Authority (CEMSIS). Numbers of admitted trauma patients (ISS >15) were obtained using statewide non-public admissions data from the California Office of Statewide Health Planning and Development (OSHPD), CEMSIS, and data from Local Emergency Medical Service Agency (LEMSA) Directors who agreed to participate in a telephone survey. Population estimates per county for 2014 were obtained from the US Census. NBATS criteria used included population, transport time, community support, and number of discharges for severely injured patients (ISS >15) at non-TCs and TCs. Estimates for the number of trauma centers per region were created for each of the 3 data sources and compared to the number of existing centers.


A total of 62 state-designated TCs were identified for California- 13 (21%) Level I, 36 (58%) Level II, 13 (11%) Level III. NBATS estimates for the total number of TCs in CA were 27-47% lower compared to the number of trauma centers in existence, but this varied based on urban/rural status. NBATS estimates were lower than current state in 70% of urban areas, but were higher almost 90% of rural areas. All data sources (OSHPD, CEMSIS, local data) produced similar results.


Estimates from the NBATS tool are different from what is currently in existence in California, and differences exist based on whether the region is rural or urban. Findings from the current study can help inform future iterations of the NBATS tool.

Level of Evidence

Economic/Decision study, Level V

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