title: Survival of patients transferred to tertiary intensive care from rural community hospitals.
abstract: BACKGROUND
  Accessibility to tertiary intensive care resources differs among hospitals within a rural region. Determining whether accessibility is associated with outcome is important for understanding the role of regionalization when providing critical care to a rural population.
  
  
  METHODS
  In a prospective design, we identified and recorded the mortality ratio, percentage of unanticipated deaths, length of stay in the intensive care unit (ICU), and survival time of 147 patients transferred directly from other hospitals and 178 transferred from the wards within a rural tertiary-care hospital.
  
  
  RESULTS
  The two groups did not differ significantly in the characteristics measured. Differences in access to tertiary critical care in this rural region did not affect survival or length of stay after admission to this tertiary ICU. The odds ratio (1.14; 95% confidence interval 0.72-1.83) for mortality associated with transfer from a rural community hospital was not statistically significant.
  
  
  CONCLUSIONS
  Patients at community hospitals in this area who develop need for tertiary critical care are just as likely to survive as patients who develop ICU needs on the wards of this rural tertiary-care hospital, despite different accessibility to tertiary intensive-care services.
authors: Section of Critical Care Medicine, Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA. stephen.d.surgenor@hitchcock.ORG
authors: S D
authors: SD
authors: Surgenor
authors: H L
authors: HL
authors: Corwin
authors: T
authors: T
authors: Clerico
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003657:Decision Making; D003953:Diagnosis-Related Groups; D005260:Female; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000458:organization & administration*; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009513:New Hampshire / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016019:Survival Analysis