Population-based study of hospital trauma care in a rural state without a formal trauma system

Citation
Fb. Rogers et al., Population-based study of hospital trauma care in a rural state without a formal trauma system, J TRAUMA, 50(3), 2001, pp. 409-413
Citations number
17
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care
Volume
50
Issue
3
Year of publication
2001
Pages
409 - 413
Database
ISI
SICI code
Abstract
Objective: Formalized systems of trauma care are believed to improve outcom es in an urban setting, but little is known of the applicability in a rural setting. Methods: We conducted a population-based analysis of hospital survival afte r trauma comparing an American College of Surgeons-verified Level I trauma center (TC) with the pooled results of 13 small community hospitals (CH) in a rural state with no formal trauma system. All patients admitted to any h ospital within the state of Vermont over a 5-year period (1995-1999) with a trauma discharge diagnosis were included. Elderly patients with isolated f emur fractures were excluded from the database. International Classificatio n of Diseases Injury Severity Scores (ICISSs) were calculated for each pati ent and used to control for injury severity in an omnibus logistic regressi on model that included age, ICISS, and hospital type (TC vs. CH) as predict ors of survival. Patients who died were characterized on the basis of ICISS into "expected" (ICISS < 0.25), "indeterminate" (ICISS = 0.26-0.50), and " unexpected" (ICISS > 0.5), Results: In 16,354 trauma admissions over the 5-year period in the rural st ate of Vermont, 370 (2.2%) died. There were 5,964 (36%) admitted to TC, Pat ients admitted to TC were more injured (ICISS 0.94 vs. 0.96) and had a high er mortality (3.1% vs. 1.8), Overall, care at the CH provided an improved s urvival (odds ratio = 1.75, 95% confidence internal = 1.31-2.18, p = 0.000) , However, in the more severely injured cohort of trauma patients (expected and indeterminate; n = 133), overall survival was higher in the TC (16% CH vs. 38% TC,p = 0.02, chi (2)). Because the TC was known to provide care eq uivalent to Major Trauma Outcome Study norms during this time period (Z = - 0.03, M = 0.894), we believe this study confirms that trauma care throughou t the state is in accordance with national norms. Conclusion: In a rural state, without a statewide formal trauma system, sur vival after trauma is no worse at CH than TC when corrected for injury seve rity and age. Future expenditures of resources might better be concentrated in other areas such as discovery or prehospital care to further improve ou tcomes.