Geographic Association Between Simulation Fellowships and Trauma Mortality

<jats:p>Introduction Trauma remains a leading cause of morbidity and mortality in the United States and places a substantial economic burden on the healthcare system. Although simulation-based training has been associated with improved trauma team performance and patient outcomes, whether emergency medicine simulation fellowship programs are associated with differences in trauma mortality remains unknown. This study examined whether counties with emergency medicine simulation fellowship programs differ in trauma mortality rates compared with counties without such programs. Methods County-level trauma mortality data (2021–2023) were obtained from the CDC WONDER Multiple Cause of Death database. The database was queried by county, year, and external cause of death. Trauma-related deaths were identified using ICD-10 external cause-of-death codes corresponding to blunt and penetrating injuries, excluding suicide. Counties with emergency medicine simulation fellowship programs were identified through publicly-available fellowship directories and classified according to the presence or absence of a simulation fellowship program. Trauma mortality rates were calculated by dividing the total number of trauma-related deaths by the cumulative county population for counties with and without simulation fellowship programs. The two mortality rates were compared using the rate ratio, 95% confidence interval, and P value calculated with the MedCalc online statistical calculator. Results Trauma mortality was 8.0 per 100,000 population in counties with emergency medicine simulation fellowship programs compared with 3.3 per 100,000 population in counties without fellowship programs (rate ratio, 2.45; P&amp;lt;0.0001). Conclusion Contrary to our hypothesis, counties with emergency medicine simulation fellowship programs demonstrated higher trauma mortality rates. Because these programs are predominantly located in urban counties, these findings may reflect greater injury severity and higher emergency department volume rather than effects of the fellowship programs themselves. These factors should be considered when interpreting the association between emergency medicine simulation fellowship programs and trauma-related mortality.</jats:p>