title: The Effect of Interhospital Transfers on the Outcome of Rural Trauma.
abstract: Urban areas house the majority of the population in the United States but trauma deaths occur more commonly in rural areas. In this study, we aimed to investigate if direct patient admission to a Level I trauma center improves outcomes in rural trauma. We retrospectively reviewed data in our trauma database from January 2008 to the end of December 2012 to compare the overall outcomes between direct admissions (DAs) and interhospital transfers (IHTs). Of the 6118 patients who met the inclusion criteria, 59.5 per cent were in the DA group and 40.5 per cent in the IHT group. Injury severity score was similar between the two groups but severe traumatic brain injury was more common (P = 0.001) in the DA group. Hospital length of stay, complication rate, and in-hospital mortality were not different between the two groups (all P> 0.2). In multivariate analysis, there was no difference in survival between the two modes of admission (odds ratio, 95% confidence interval: 0.91, 0.69-1.20, P = 0.51). We concluded that rural trauma IHTs had no detrimental impact on the outcome. Prospective studies would better elucidate factors associated with patient outcomes in rural trauma.
authors.affiliation: Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wild
authors.forename: Jabran M
authors.initials: JM
authors.lastname: Younus
authors.forename: Mahdi
authors.initials: M
authors.lastname: Malekpour
authors.forename: Nina
authors.initials: N
authors.lastname: Neuhaus
authors.forename: Kenneth
authors.initials: K
authors.lastname: Widom
authors.forename: Megan
authors.initials: M
authors.lastname: Rapp
authors.forename: Diane
authors.initials: D
authors.lastname: Leonard
authors.forename: Susan
authors.initials: S
authors.lastname: Baro
authors.forename: James
authors.initials: J
authors.lastname: Dove
authors.forename: Marie
authors.initials: M
authors.lastname: Hunsinger
authors.forename: Joseph
authors.initials: J
authors.lastname: Blansfield
authors.forename: Mohsen
authors.initials: M
authors.lastname: Shabahang
authors.forename: Denise
authors.initials: D
authors.lastname: Torres
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality*