BACKGROUND: Patients injured in rural counties are hypothesized to have improved survival if local hospitals are categorized as Level III, Level IV, and Level V trauma centers. METHODS: Data were abstracted on patients with brain, liver, or spleen injuries who were first treated in 16 rural hospitals in Oregon (with categorized trauma centers) and 16 hospitals in Washington (without categorized trauma centers). Logistic regression models evaluated survival up to 30 days after hospital discharge. RESULTS: Among Oregon's 642 study patients, 63% were transferred to another hospital. Among Washington's 624 patients, a higher proportion, 70%, were transferred. Risk-adjusted odds of death for Washington patients (reference odds, 1) were the same as for Oregon patients (odds ratio, 0.82; 95% confidence interval, 0.53-1.28). Most patients died after transfer to another hospital. CONCLUSION: In states with a prevailing practice of promptly transferring brain-injured patients, survival of these patients may not be enhanced by categorization of hospitals as rural trauma centers. To further improve the outcome of these patients, policy makers should adjust statewide trauma system guidelines to enhance integration and to perfect coordination among sequential decision makers.
BACKGROUND:Patients injured in rural counties are hypothesized to have improved survival if local hospitals are categorized as Level III, Level IV, and Level V trauma centers. METHODS: Data were abstracted on patients with brain, liver, or spleen injuries who were first treated in 16 rural hospitals in Oregon (with categorized trauma centers) and 16 hospitals in Washington (without categorized trauma centers). Logistic regression models evaluated survival up to 30 days after hospital discharge. RESULTS: Among Oregon's 642 study patients, 63% were transferred to another hospital. Among Washington's 624 patients, a higher proportion, 70%, were transferred. Risk-adjusted odds of death for Washingtonpatients (reference odds, 1) were the same as for Oregon patients (odds ratio, 0.82; 95% confidence interval, 0.53-1.28). Most patients died after transfer to another hospital. CONCLUSION: In states with a prevailing practice of promptly transferring brain-injured patients, survival of these patients may not be enhanced by categorization of hospitals as rural trauma centers. To further improve the outcome of these patients, policy makers should adjust statewide trauma system guidelines to enhance integration and to perfect coordination among sequential decision makers.
Authors: K John McConnell; Craig D Newgard; Richard J Mullins; Melanie Arthur; Jerris R Hedges Journal: Health Serv Res Date: 2005-04 Impact factor: 3.402
Authors: Kate B Carey; Andrew J McClurg; Jamie R Bolles; Suzanne J Hubbell; Heather A Will; Michael P Carey Journal: J Public Health Manag Pract Date: 2009 Nov-Dec
Authors: Thomas Kristiansen; Hans M Lossius; Kjetil Søreide; Petter A Steen; Christine Gaarder; Pål A Næss Journal: J Trauma Manag Outcomes Date: 2011-06-16
Authors: Richard Fleet; Fatoumata Korika Tounkara; Mathieu Ouimet; Gilles Dupuis; Julien Poitras; Alain Tanguay; Jean Paul Fortin; Jean-Guy Trottier; Jean Ouellet; Gilles Lortie; Jeff Plant; Judy Morris; Jean Marc Chauny; François Lauzier; France Légaré Journal: BMJ Open Date: 2016-04-20 Impact factor: 2.692