Thursday, October 13, 2016

Rural patients less likely to go to trauma centers, more likely to die in first 24 hours, says study

Triage sensitivity and specificity estimates for rural
patients (OHSU chart; click on it for a larger version)
Critical trauma patients from rural areas in the Pacific Northwest are far less likely than urban patients to be taken to a major trauma center. That's not surprising, but an apparent effect is more important: Rural trauma patients are more likely to die within the first 24 hours, says a study by Oregon Health & Science University published in JAMA Surgery.

Researchers found that 29.4 percent of rural patients needing critical care were initially transported to a trauma center, compared to 88.7 percent of urban patients. When accounting for transfers, 39.8 percent of rural patients were cared for in trauma centers, compared to 88.7 percent of urban patients. While overall mortality rates were similar, 89.6 percent of rural deaths occurred in the first 24 hours, compared to 64 percent of urban deaths.

Not only do rural patients have longer distances to travel to a major trauma center, they may choose to be hospitalized closer to home, OHSU doctor Craig Newgard, the lead author of the study, Sue Vorenberg of the Portland Business Journal. Many high-risk rural patients “never make it to a major trauma center. And the explanation for that is kind of complicated. There’s no one easy thing to point to, Newgard said. “We may need a culture change by providers, recognizing that seriously injured patients in rural areas need to be transferred to a major trauma center more quickly.

The study looked at 2011 data from 67,047 people (1,971 of them rural) transported by EMS to 28 hospitals in Oregon and Washington. "Among the 53,487 patients transported by EMS, a stratified probability sample of 17,633 patients (1,438 rural and 16,195 urban) was created to track hospital outcomes (78.9 percent with in-hospital follow-up)."

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