title: A needs assessment for regionalization of trauma care in a rural state.
abstract: Systems of trauma care in urban areas have a demonstrated survival benefit. Little is known of the benefit of trauma system organization in rural areas. We hypothesized that examination of all trauma deaths during a 1-year period would provide opportunities to improve care in our rural state. We used a medical examiner database of trauma deaths occurring during a 1-year period. Five board-certified surgeons analyzed deaths as preventable (P), potentially preventable (PP), and non-preventable (NP) using modified Delphi technique. There were 223 trauma deaths during a 1-year period. Most (63%) died at the scene prior to any medical intervention. Adjudication of the deaths demonstrated 5 P (2%; 95% CI 1-5%), 36 PP (16%; 95% CI 12-27%), and 179 NP (81%; 95% CI 76-86%). Agreement among trauma surgeons was only moderate with a k of 0.46. Suicide accounted for a significant number of the overall trauma deaths at 32 per cent. Rural trauma system design should focus on discovery, as that is where the majority of deaths occur. Suicide is a significant problem in this rural state that should be aggressively targeted with prevention programs.
authors.affiliation: Department of Surgery-Division of Trauma, University of Vermont College of Medicine, Burlington, Vermont, USA.
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Rogers
authors.forename: Lynn
authors.initials: L
authors.lastname: Madsen
authors.forename: Steven
authors.initials: S
authors.lastname: Shackford
authors.forename: Bruce
authors.initials: B
authors.lastname: Crookes
authors.forename: William
authors.initials: W
authors.lastname: Charash
authors.forename: Paul
authors.initials: P
authors.lastname: Morrow
authors.forename: Turner
authors.initials: T
authors.lastname: Osler
authors.forename: Randeep
authors.initials: R
authors.lastname: Jawa
authors.forename: Jill A
authors.initials: JA
authors.lastname: Rebuck
authors.forename: Peter
authors.initials: P
authors.lastname: Igneri
mesh_terms: D005260:Female; D006780:Hospitals, Rural / Q000458:organization & administration; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D020380:Needs Assessment; D012041:Regional Medical Programs / Q000458:organization & administration*; D012189:Retrospective Studies; D012424:Rural Population; D014193:Trauma Centers / Q000458:organization & administration*; D014707:Vermont; D014947:Wounds and Injuries / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy*