title: Survival of seriously injured patients first treated in rural hospitals.
abstract: BACKGROUND
  Patients injured in rural counties are hypothesized to have improved survival if local hospitals are categorized as Level III, Level IV, and Level V trauma centers.
  
  
  METHODS
  Data were abstracted on patients with brain, liver, or spleen injuries who were first treated in 16 rural hospitals in Oregon (with categorized trauma centers) and 16 hospitals in Washington (without categorized trauma centers). Logistic regression models evaluated survival up to 30 days after hospital discharge.
  
  
  RESULTS
  Among Oregon's 642 study patients, 63% were transferred to another hospital. Among Washington's 624 patients, a higher proportion, 70%, were transferred. Risk-adjusted odds of death for Washington patients (reference odds, 1) were the same as for Oregon patients (odds ratio, 0.82; 95% confidence interval, 0.53-1.28). Most patients died after transfer to another hospital.
  
  
  CONCLUSIONS
  In states with a prevailing practice of promptly transferring brain-injured patients, survival of these patients may not be enhanced by categorization of hospitals as rural trauma centers. To further improve the outcome of these patients, policy makers should adjust statewide trauma system guidelines to enhance integration and to perfect coordination among sequential decision makers.
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, Oregon 97201-3098, USA. mullinsr@ohsu.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Mullins
authors.forename: Jerris R
authors.initials: JR
authors.lastname: Hedges
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Rowland
authors.forename: Melanie
authors.initials: M
authors.lastname: Arthur
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Price
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Olson
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D016015:Logistic Models; D008297:Male; D009922:Oregon; D010360:Patient Transfer; D012042:Registries; D012189:Retrospective Studies; D012423:Rural Health / Q000706:statistics & numerical data; D013154:Spleen / Q000293:injuries*; D016019:Survival Analysis; D014193:Trauma Centers / Q000145:classification / Q000706:statistics & numerical data*; D014861:Washington; D014948:Wounds, Gunshot / Q000401:mortality