Details:

Alternative Title:
JAMA Surg
Personal Author:
Newgard, Craig D. ; Fu, Rongwei ; Bulger, Eileen ; Hedges, Jerris R. ; Mann, N. Clay ; ... More +
Newgard, Craig D. ; Fu, Rongwei ; Bulger, Eileen ; Hedges, Jerris R. ; Mann, N. Clay ; Wright, Dagan A. ; Lehrfeld, David P. ; Shields, Carol ; Hoskins, Gregory ; Warden, Craig ; Wittwer, Lynn ; Cook, Jennifer N. B. ; Verkest, Michael ; Conway, William ; Somerville, Stephanie ; Hansen, Matthew Less -
Description:
Importance

Despite a large rural US population, there are potential differences between rural and urban regions in the processes and outcomes following trauma.

Objectives

To describe and evaluate rural vs urban processes of care, injury severity, and mortality among injured patients served by 9-1-1 emergency medical services (EMS).

Design, Setting, and Participants

This was a preplanned secondary analysis of a prospective cohort enrolled from January 1 through December 31, 2011, and followed up through hospitalization. The study included 44 EMS agencies transporting to 28 hospitals in 2 rural and 5 urban counties in Oregon and Washington. A population-based, consecutive sample of 67047 injured children and adults served by EMS (1971 rural and 65 076 urban) was enrolled. Among the 53 487 patients transported by EMS, a stratified probability sample of 17 633 patients (1438 rural and 16 195 urban) was created to track hospital outcomes (78.9% with in-hospital follow-up). Data analysis was performed from June 12, 2015, to May 20, 2016.

Exposures

Rural was defined at the county level by 60 minutes or more driving proximity to the nearest level I or II trauma center and/or rural designation in the Centers for Medicare & Medicaid Services ambulance fee schedule by zip code.

Main outcomes and Measures

Mortality (out-of-hospital and in-hospital), need for early critical resources, and transfer rates.

Results

Of the 53 487 injured patients transported by EMS (17 633 patients in the probability sample), 27 535 were women (51.5%); mean (SD) age was 51.6 (26.1) years. Rural vs urban sensitivity of field triage for identifying patients requiring early critical resources was 65.2% vs 80.5%, and only 29.4% of rural patients needing critical resources were initially transported to major trauma centers vs 88.7% of urban patients. After accounting for transfers, 39.8% of rural patients requiring critical resources were cared for in major trauma centers vs 88.7% of urban patients. Overall mortality did not differ between rural and urban regions (1.44% vs 0.89%; P = .09); however, 89.6% of rural deaths occurred within 24 hours compared with 64% of urban deaths. Rural regions had higher transfer rates (3.2% vs 2.7%) and longer transfer distances (median, 97.4 km; interquartile range [IQR], 51.7-394.5 km; range, 47.8-398.6 km vs 22.5 km; IQR, 11.6-24.6 km; range, 3.5-97.4 km).

Conclusions and Relevance

Most high-risk trauma patients injured in rural areas were cared for outside of major trauma centers and most rural trauma deaths occurred early, although overall mortality did not differ between regions. There are opportunities for improved timeliness and access to major trauma care among patients injured in rural regions.


Subjects:
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Article
Source:
JAMA Surg. 152(1):11-18.
Pubmed ID:
27732713
Pubmed Central ID:
PMC5409522
Document Type:
Journal Article
Funding:
R01 CE001837/CE/NCIPC CDC HHS/United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:1be6f672b685328d940bc1c705e07d4d01c4fe190d07da33bc921a6b4788a981
Download URL:
https://stacks.cdc.gov/view/cdc/45427/cdc_45427_DS1.pdf
File Type:

Supporting Files

• 	NIHMS848008-supplement-Supplement.docx	docx
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