title: Trauma care in a combined rural and urban region: an observational study.
abstract: BACKGROUND
  The available information on trauma care in mixed rural-urban areas with scattered populations is limited. The aim of this study is to describe epidemiology, resource use, transfers and outcomes for trauma care within such an area, prior to implementation of a formal trauma system.
  
  
  METHODS
  A multicentre observational study including potential severely injured patients from June 2007 to May 2010. All patients received by trauma teams at seven acute care hospitals (ACH) and one major trauma centre (MTC) were included. Major trauma was defined as Injury Severity Score (ISS) > 15.
  
  
  RESULTS
  A total of 2323 patients were included. ACH received 1330 patients and delivered definite care to 85% of these. Only 329 (14%) patients were major trauma of which 134 (41%) were initially received at an ACH. Nine per cent of patients were transferred between hospitals. After inter-hospital transfers, 79% of all major trauma patients received definite care at the MTC. Helicopter emergency services admitted 52% of major trauma and performed 68% of inter-hospital transfers from ACH to MTC. Forty-eight patients (2%) died within 30 days.
  
  
  CONCLUSIONS
  In a region with a dispersed network of hospitals, geographical challenges, and low rate of major trauma cases, efforts should be made to identify patients with major trauma for treatment at a MTC as early as possible. This can be done by implementing triage and transfer guidelines, maintaining competence at ACHs for initial stabilization, and sustaining an organization for effective inter-facility transfers.
authors.affiliation: Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, Trondheim, Norway.|Department of Circulation and Medical Imaging, Faculty of medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: O
authors.initials: O
authors.lastname: Uleberg
authors.affiliation: Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Kristiansen
authors.affiliation: Department of Public Health, Faculty of medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Pape
authors.affiliation: Department of Public Health, Faculty of medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: P R
authors.initials: PR
authors.lastname: Romundstad
authors.affiliation: Department of Circulation and Medical Imaging, Faculty of medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Anaesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: P
authors.initials: P
authors.lastname: Klepstad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006295:Health Resources; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000628:therapy*