title: From the barn to the operating room and back: the Amish way of life leads to improved throughput and outcomes following trauma.
abstract: BACKGROUND
  The Amish culture is known for simple living, reluctance to use modern technology, and a heavy emphasis on church and family relationships. We hypothesized that the strong work ethic and social structure of the Amish would lead to improved outcome following trauma.
  
  
  METHODS
  Trauma registry was queried for all patients from years 2000 to 2010. Patients separated into Amish versus non-Amish. Groups were compared using univariate logistic regression, with the first outcome variable being mortality and the second being hospital length of stay (LOS) greater than 5 days. Factors significant on univariate analysis were included in the multivariate models for the same dependent variables.
  
  
  RESULTS
  From 2000 to 2010, our Level II trauma center admitted 18,337 trauma patients, 802 (4.4%) of whom were Amish. When adjusted for age of 65 years or older, Injury Severity Score (ISS) of 16 or greater, and the occurrence of at least one complication, the Amish are at 96% lower odds for having an overall hospital LOS greater than 5 days (odds ratio, 0.51; 95% confidence interval, 0.40-0.66; p < 0.001). The Amish have a 72% lower odds of dying following trauma, when controlling for age of 65 years or older, Glasgow Coma Scale (GCS) score of 13 or less, ISS of 16 or greater, and Revised Trauma Score (RTS) of 7 or less (odds ratio, 0.58; 95% confidence interval, 0.33-0.96; p = 0.036). The hospital LOS model had a receiver operating characteristic curve of 0.77, and the mortality model had a receiver operating characteristic curve of 0.88.
  
  
  CONCLUSIONS
  When adjusted for injury severity, age, and physiology, the Amish have a 72% lower odds of dying following trauma than their non-Amish counterparts. When adjusted for injury severity, age, physiology, and complications, the Amish have a 96% lower odds of having an extended hospital LOS than their non-Amish counterparts. Understanding the unique social structure of the Amish population may allow scarce social services' resources to be shifted to more underserved areas.
  
  
  METHODS
  Epidemiologic, level III.
authors.affiliation: From the Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
authors.forename: Amelia
authors.initials: A
authors.lastname: Rogers
authors.forename: Michael
authors.initials: M
authors.lastname: Horst
authors.forename: Frederick
authors.initials: F
authors.lastname: Rogers
authors.forename: John
authors.initials: J
authors.lastname: Lee
authors.forename: Michael
authors.initials: M
authors.lastname: Reihart
mesh_terms: D000368:Aged; D061365:Amish / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000639:trends; D008019:Life Style / Q000208:ethnology*; D008297:Male; D009873:Operating Rooms; D010414:Pennsylvania; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000208:ethnology / Q000601:surgery*