title: A comparison of rural versus urban trauma care.
abstract: OBJECTIVE
  We compared the survival of trauma patients in urban versus rural settings after the implementation of a novel rural non-trauma center alternative care model called the Model Rural Trauma Project (MRTP).
  
  
  METHODS
  We conducted an observational cohort study of all trauma patients brought to eight rural northern California hospitals and two southern California urban trauma centers over a one-year period (1995-1996). Trauma patients with an injury severity score (ISS) of >10 were included in the study. We used logistic regression to assess disparities in odds of survival while controlling for Trauma and Injury Severity Score (TRISS) parameters.
  
  
  RESULTS
  A total of 1,122 trauma patients met criteria for this study, with 336 (30%) from the rural setting. The urban population was more seriously injured with a higher median ISS (17 urban and 14 rural) and a lower Glasgow Coma Scale (GCS) (GCS 14 urban and 15 rural). Patients in urban trauma centers were more likely to suffer penetrating trauma (25% urban versus 9% rural). After correcting for differences in patient population, the mortality associated with being treated in a rural hospital (OR 0.73; 95% CI 0.39 to 1.39) was not significantly different than an urban trauma center.
  
  
  CONCLUSIONS
  This study demonstrates that rural and urban trauma patients are inherently different. The rural system utilized in this study, with low volume and high blunt trauma rates, can effectively care for its population of trauma patients with an enhanced, committed trauma system, which allows for expeditious movement of patients toward definitive care.
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA ; Department of The Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, CA, USA ; Department of The Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
authors.forename: Ari M
authors.initials: AM
authors.lastname: Lipsky
authors.affiliation: Department of The North-Coast Emergency Medical Services Agency, Humboldt, CA, USA.
authors.forename: Larry L
authors.initials: LL
authors.lastname: Karsteadt
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA ; Department of The Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, CA, USA ; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Gausche-Hill
authors.affiliation: Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA ; Department of The Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, CA, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hartmans
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, CA, USA ; Department of The Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, CA, USA ; Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Bongard
authors.affiliation: Department of Surgery, UCLA Medical Center, Los Angeles, CA, USA ; Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Henry Gill
authors.initials: HG
authors.lastname: Cryer
authors.affiliation: Department of Nursing, Harbor-UCLA Medical Center, Torrance, CA, USA ; Department of The Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, CA, USA.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Ekhardt
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA ; Department of The Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, CA, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Loffredo
authors.affiliation: Department of The North-Coast Emergency Medical Services Agency, Humboldt, CA, USA.
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Farmer
authors.affiliation: Department of The North-Coast Emergency Medical Services Agency, Humboldt, CA, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Whitney
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA ; Department of The Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, CA, USA ; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Lewis
keywords: Major trauma outcome study; rural trauma; urban trauma center