Study of the Outcome of Patients Transferred to a Level I Hospital after Stabilization at an Outlying Hospital in a Rural Setting

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Abstract
To determine the characteristics and outcome of transferred trauma patients in a rural setting. We conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital. We used prehospital times, Injury Severity Score (ISS), LD50ISS (the ISS at which 50% of patients died), Revised Trauma Score, probability of survival, Acute Physiology and Chronic Health Evaluation II, and observed survival as main outcome measures. RTTPs (39.4%) spent an average of 182 +/- 139 minutes at the outlying hospital and 72 +/- 42 minutes in transport to the trauma center. Proportionately more head/neck and patients with multiple injuries composed the RTTP group. The RTTP were more severely injured (ISS 11.1 +/- 8.5; Acute Physiology and Chronic Health Evaluation II 16.2 +/- 5.8; Revised Trauma Score 7.44 +/- 1.1) than the trauma patients admitted directly (ISS 7.9 +/- 5.3; Acute Physiology and Chronic Health Evaluation II 13.1 +/- 6.3; Revised Trauma Score 7.8 +/- 0.4; p < 0.05). However, both groups had the same LD50ISS (ISS = 35). When logistic regression was applied with death as the dependent variable, both ISS and age contributed significantly (p = 0.0001) but transfer status did not (p = 0.473). Rural trauma centers admit a high percentage of RTTP. These RTTP have a higher injury severity and acuity than their trauma patients admitted directly counterparts. Trauma care in rural areas that involves initial stabilization at outlying hospitals does not adversely affect mortality.