title: Scottish urban versus rural trauma outcome study.
abstract: BACKGROUND
  Outcome following trauma and health care access are important components of health care planning. Resources are limited and quality information is required. We set the objective of comparing the outcomes for patients suffering significant trauma in urban and rural environments in Scotland.
  
  
  METHODS
  The study was designed as a 2 year prospective observational study set in the west of Scotland, which has a population of 2.58 million persons. Primary outcome measures were defined as the total number of inpatient days, total number of intensive care unit days, and mortality. The participants were patients suffering moderate (ISS 9-15) and major (ISS>15) trauma within the region. The statistical analysis consisted of chi square test for categorical data and Mann Whitney U test for comparison of medians.
  
  
  RESULTS
  There were 3,962 urban (85%) and 674 rural patients (15%). Urban patients were older (50 versus 46 years, p = 0.02), were largely male (62% versus 57%, p = 0.02), and suffered more penetrating traumas (9.9% versus 1.9%, p < 0.001). All prehospital times are significantly longer for rural patients (p < 0.001), include more air ambulance transfers (p < 0.001), and are characterized by greater paramedic presence (p < 0.001). Excluding neurosurgical and spinal injuries transfers, there was a higher proportion of transfers in the rural major trauma group (p = 0.002). There were more serious head injuries in the urban group (p = 0.04), and also a higher proportion of urban patients with head injuries transferred to the regional neurosurgical unit (p = 0.037). There were no differences in length of total inpatient stay (median 8 days, p = 0.7), total length of stay in the intensive care unit (median two days, p = 0.4), or mortality (324 deaths, moderate trauma, p = 0.13; major trauma, p = 0.8).
  
  
  CONCLUSIONS
  Long prehospital times in the rural environment were not associated with differences in mortality or length of stay in moderately and severely injured patients in the west of Scotland. This may lend support to a policy of rationalization of trauma services in Scotland.
authors.affiliation: Crosshouse Hospital, Kilmarnock, Scotland. Crawford.McGuffie@aaaht.scot.nhs.uk
authors.forename: A Crawford
authors.initials: AC
authors.lastname: McGuffie
authors.forename: Colin A
authors.initials: CA
authors.lastname: Graham
authors.forename: Diana
authors.initials: D
authors.lastname: Beard
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Henry
authors.forename: Michael O
authors.initials: MO
authors.lastname: Fitzpatrick
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Wilkie
authors.forename: Gary W
authors.initials: GW
authors.lastname: Kerr
authors.forename: Timothy R J
authors.initials: TR
authors.lastname: Parke
mesh_terms: D002391:Catchment Area, Health; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data; D011446:Prospective Studies; D019035:Rural Health Services; D012606:Scotland / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D015599:Trauma Severity Indices; D019037:Urban Health Services; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*