Authors: Newgard CD et al., JAMA Surg 2016 Oct 12;
Patients injured in rural settings were less likely to be cared for in a trauma center than those injured in urban settings, yet mortality didn’t differ between groups.
Several studies have shown worse outcomes for patients with injuries that occur in rural versus urban settings, and have suggested that this may result from differences in injury severity, transport time, prehospital interventions, or access to trauma center care. To discriminate the effects of these factors, researchers conducted a secondary analysis of prospectively collected data on injuries, triage, field interventions, and outcomes for patients who called 911 for an injury in seven counties (5 urban, 2 rural) in Washington and Oregon during 2011.
Mean response times (10.1 vs. 6.3 minutes) and transport times (16.8 vs. 15.3 minutes) were significantly longer for rural patients than for urban patients (although perhaps less significantly than one would intuit), but mean on-scene intervals were similar (19 minutes). Rural patients who required early (<24 hours) interventions, such as intubation, massive transfusion, or surgery, were less likely to receive care in a trauma center than urban patients (40% vs. 89%). Although overall mortality was similar in both groups (0.74%), mortality in the first 24 hours was significantly higher in rural than in urban patients (0.65% vs. 0.13%). This was driven by differences in prehospital mortality, which accounted for 52% of rural deaths, compared to 25% of urban deaths.
In rural areas, even seriously injured patients are transported to the closest hospital, regardless of its trauma center status. Adding 25 or more minutes (each way) to the transport time of critically ill patients would increase out-of-service time for emergency medical services and could delay interventions. To improve outcomes for rural trauma victims, we should target resources to prehospital care.