title: Outcomes of pediatric trauma patients transported from rural and urban scenes.
abstract: OBJECTIVE
  Mortality differences exist between victims of urban and rural trauma. It is unknown if these differences persist in those patients who survive to HEMS transport. This study examined the in-hospital mortality, hospital LOS, and discharge status of pediatric blunt trauma victims transported by HEMS from rural and urban scenes.
  
  
  METHODS
  Retrospective review of pediatric (< 17) transports between 1997 and 2001. 130 rural and 419 urban pediatric patients transported to area trauma centers were identified from HEMS and registry records.
  
  
  RESULTS
  Total mileage, flight times, and scene times were significantly longer for rural flights (P < 0.05). There were no significant differences between the groups with regard to age, gender, vitals, hospital/ICU days, and mortality. After controlling for ISS and mechanism of injury, urban patients were 9 times more likely to die compared to rural patients.
  
  
  CONCLUSIONS
  Pediatric patients injured in urban areas had shorter total flight and scene times than pediatric patients flown from rural scenes. Higher adjusted in-hospital mortality rates in the urban group were likely a result of faster EMS response and transport times, which minimized out-of-hospital deaths. Factors prior to HEMS arrival may have more impact on the increased mortality rates of rural blunt trauma victims documented nationally.
authors.affiliation: Emergency Department Clinical Operations, University of Utah School of Medicine, Salt Lake City, UT 84132, USA. Christy.mccowan@hsc.utah.edu
authors.forename: Christy L
authors.initials: CL
authors.lastname: McCowan
authors.forename: Eric R
authors.initials: ER
authors.lastname: Swanson
authors.forename: Frank
authors.initials: F
authors.lastname: Thomas
authors.forename: Diana L
authors.initials: DL
authors.lastname: Handrahan
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality; D000293:Adolescent; D017732:Air Ambulances / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality*