ATLS adherence in the transfer of rural trauma patients to a level I facility.
BACKGROUND
Injury sustained in rural areas has been shown to carry higher mortality rates than trauma in urban settings. This disparity is partially attributed to increased distance from definitive care and underscores the importance of proper primary trauma management prior to transfer to a trauma facility. The purpose of this study was to assess Advanced Trauma Life Support (ATLS) guideline adherence in the management of adult trauma patients transferred from rural hospitals to a level I facility.


METHODS
We performed a retrospective analysis of all adult major trauma patients transferred ≥50km from an outlying hospital to a level I trauma centre from 2007 through 2009. Transfer practices were evaluated using ATLS guidelines.


RESULTS
646 patients were analyzed. Mean age was 40.5years and 94% sustained blunt injuries with a median Injury Severity Score (ISS) of 22. Median transport distance was 253km. Among all patients, there were notable deficiencies (<80% adherence) in 8 of 11 ATLS recommended interventions, including patient rewarming (8% adherence), chest tube insertion (53%), adequate IV access (53%), and motor/sensory exam (72%). Patients with higher ISS scores, and those transferred by air were more likely to receive ATLS recommended interventions.


CONCLUSIONS
Key aspects of ATLS resuscitation guidelines are frequently missed during transfer of trauma patients from the periphery to level I trauma centres. Comprehensive quality improvement initiatives, including targeted education, telemedicine and trauma team training programmes could improve quality of care.
Department of Surgery, University of Alberta, Canada. mccrum@ualberta.ca
Marta L
ML
McCrum
Jessica
J
McKee
Michael
M
Lai
John
J
Staples
Noah
N
Switzer
Sandy L
SL
Widder
D000293:Adolescent; D000328:Adult; D061906:Advanced Trauma Life Support Care / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000193:education; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006780:Hospitals, Rural; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D010360:Patient Transfer / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014947:Wounds and Injuries; D055815:Young Adult