Does rurality affect the outcome of trauma patients?.

Abstract

To determine the impact of rurality in epidemiology, injury severity, health care facilities, length of stay, mortality, functional outcome and quality of life in severe trauma patients.All trauma patients admitted in our Emergency Room between 2001 and 2007. Data was collected from the prospective Trauma Registry and Follow-Up Registry 6 months after the accident. Patients were divided in three groups according to residence area: R (rural), SU (semi-urban) and U (urban). Sex, age, type of injury, length of stay in hospital and intensive care, anatomic severity (AIS), politrauma severity (ISS), physiologic severity (RTS), surveillance probability (TRISS index), pre-hospital care, previous admission in other hospital, intensive care admission, Euroqol and Extended Glasgow Outcome scale and mortality were studied in order to find a relation with rurality.1150 patients were analyzed (214 rural, 219 semi-urban, 717 urban). We found a statistical significant relation between rurality and pre-hospital care with rural patients having less medical approach in pre-hospital (R group: 12,2%; SU group: 17,7%; U group: 70,1%, p < 0,001), previous admission in other hospital with rural patients being more often admitted in another hospital before transfer to the trauma centre (R group: 89,2%; SU group: 85,8%; U group: 61,9%, p < 0,001) and intensive care admission (R group: 82,2%; SU group: 78,5%; U group: 72,4%, com p < 0,006). We did not find any significant relation between other variables studied namely severity and early or late outcome.Living in rural areas does not seam to give more burden of disease to severe trauma patients. Rural patients are similar to those that live in urban areas concerning epidemiology, injury severity and outcome. Despite lack of medical pre-hospital care and higher previous admission in other hospital in rural patients, mortality between groups didn't differ in our trauma centre.