title: Does direct transport to provincial burn centres improve outcomes? A spatial epidemiology of severe burn injury in British Columbia, 2001-2006.
abstract: BACKGROUND
  In Canada and the United States, research has shown that injured patients initially treated at smaller emergency departments before transfer to larger regional facilities are more likely to require longer stays in hospital or suffer greater mortality. It remains unknown whether transport status is an independent predictor of adverse health events among persons requiring care from provincial burn centres.
  
  
  METHODS
  We obtained case records from the British Columbia Trauma Registry for adult patients (age ≥ 18 yr) referred or transported directly to the Vancouver General Hospital and Royal Jubilee Hospital burn centres between Jan. 1, 2001, and Mar. 31, 2006. Prehospital and in-transit deaths and deaths in other facilities were identified using the provincial Coroner Service database. Place of injury was identified through data linkage with census records. We performed bivariate analysis for continuous and discrete variables. Relative risk (RR) of prehospital and in-hospital mortality and hospital stay by transport status were analyzed using a Poisson regression model.
  
  
  RESULTS
  After controlling for patient and injury characteristics, indirect referral did not influence RR of in-facility death (RR 1.32, 95% confidence interval [CI] 0.54- 3.22) or hospital stay (RR 0.96, 95% CI 0.65-1.42). Rural populations experienced an increased risk of total mortality (RR 1.22, 95% CI 1.00-1.48).
  
  
  CONCLUSIONS
  Transfer status is not a significant indicator of RR of death or hospital stay among patients who received care at primary care facilities before transport to regional burn centres. However, significant differences in prehospital mortality show that improvements in rural mortality can still be made.
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, BC. nathaniel.bell@vch.ca
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Bell
authors.forename: Richard
authors.initials: R
authors.lastname: Simons
authors.forename: S Morad
authors.initials: SM
authors.lastname: Hameed
authors.forename: Nadine
authors.initials: N
authors.lastname: Schuurman
authors.forename: Stephen
authors.initials: S
authors.lastname: Wheeler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D016638:Critical Illness / Q000628:therapy; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D012042:Registries; D012151:Resuscitation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult