title: Short-term outcome and differences between rural and urban trauma patients treated by mobile intensive care units in Northern Finland: a retrospective analysis.
abstract: BACKGROUND
  Emergency medical services are an important part of trauma care, but data comparing urban and rural areas is needed. We compared 30-day mortality and length of intensive care unit (ICU) stay for trauma patients injured in rural and urban municipalities and collected basic data on trauma care in Northern Finland.
  
  
  METHODS
  We examined data from all trauma patients treated by the Finnish Helicopter Emergency Medical Services in 2012 and 2013. Only patients surviving to hospital were included in the analysis but all pre-hospital deaths were recorded. All data was retrieved from the national Helicopter Emergency Medical Services database, medical records, and the Finnish Causes of Death Registry. Patients were defined as urban or rural depending on the type of municipality where the injury occurred.
  
  
  RESULTS
  A total of 472 patients were included. Age and Injury Severity Score did not differ between rural and urban patients. The pre-hospital time intervals and distances to trauma centers were longer for rural patients and a larger proportion of urban patients had intentional injuries (23.5% vs. 9.3%, P <0.001). The 30-day mortality for severely injured patients (Injury Severity Score >15) was 23.9% in urban and 13.3% in rural municipalities. In the multivariate regression analysis the odds ratio (OR) for 30-day mortality was 2.8 (95% confidence interval 1.0 to 7.9, P = 0.05) in urban municipalities. There was no difference in the length of ICU stay or scores. Twenty patients died on scene or during transportation and 56 missions were aborted because of pre-hospital death.
  
  
  CONCLUSIONS
  The severely injured urban trauma patients had a trend toward higher 30-day mortality compared with patients injured in rural areas but the length of ICU stay was similar. However, more pre-hospital deaths occurred in rural municipalities. The time before mobile ICU arrival appears to be critical for trauma patients' survival, especially in rural areas.
authors.affiliation: Department of Anaesthesia and Intensive Care, Lapland Central Hospital, Rovaniemi, Finland. lasse.raatiniemi@gmail.com.|Centre for Pre-Hospital Emergency Services, Oulu University Hospital, Oulu, Finland. lasse.raatiniemi@gmail.com.|Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland. lasse.raatiniemi@gmail.com.
authors.forename: Lasse
authors.initials: L
authors.lastname: Raatiniemi
authors.affiliation: Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland.|Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: Janne
authors.initials: J
authors.lastname: Liisanantti
authors.affiliation: Faculty of Medicine, University of Oulu, Oulu, Finland.
authors.forename: Suvi
authors.initials: S
authors.lastname: Niemi
authors.affiliation: Centre for Pre-Hospital Emergency Services, Oulu University Hospital, Oulu, Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Nal
authors.affiliation: Division of Operative Care, Oulu University Hospital, Oulu, Finland.|Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: Department of Geography, University of Oulu, Oulu, Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Antikainen
authors.affiliation: Centre for Pre-Hospital Emergency Services, Oulu University Hospital, Oulu, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Martikainen
authors.affiliation: Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Alahuhta
mesh_terms: D000328:Adult; D017732:Air Ambulances / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005387:Finland; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012424:Rural Population; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014187:Transportation of Patients / Q000379:methods; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014505:Urban Population; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D055815:Young Adult