A national assessment of trauma systems using the American college of surgeons NBATS tool: Geographic distribution of trauma center need

Document Type



General Surgery


Objective: To compare the Needs Based Assessment of Trauma Systems (NBATS) tool estimates of trauma center need to the existing trauma infrastructure using observed national trauma volume.
Summary background data: Robust trauma systems have improved outcomes for severely injured patients. The NBATS tool was created by the American College of Surgeons (ACS) to align trauma resource allocation with regional needs.
Methods: Data from the Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project State Inpatient Databases, the Trauma Information Exchange Program, and US Census was used to calculate an NBATS score for each trauma service area (TSA) as defined by the Pittsburgh Atlas. This score was used to estimate the number of trauma centers allocated to each TSA and compared to the number of existing trauma centers.
Results: NBATS predicts the need for 117 additional trauma centers across the United States in order to provide adequate access to trauma care nationwide. At least one additional trauma center is needed in 49% of trauma service areas.
Conclusions: Application of the NBATS tool nationally shows the need for additional trauma infrastructure across a large segment of the United States. We identified some limitations of the NBATS tool, including preferential weighting based on current infrastructure. The NBATS tool provides a good framework to begin the national discussion around investing in the expansion of trauma systems nationally, however in many instances lacks the granularity to drive change at the local level.

Publication (Name of Journal)

Annals of Surgery