M. P. Jarman2, R. C. Castillo2, A. R. Carlini2, A. H. Haider1 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 2Johns Hopkins Bloomberg School Of Public Health,Department Of Health Policy And Management,Baltimore, MD, USA
Introduction: Treatment at a designated trauma center is proven to reduce mortality from traumatic brain injury, but the majority of US residents in rural areas do not have timely access to Level I or II trauma centers. Rural residents also face elevated risk of traumatic brain injury compared to non-rural residents, and may experience more severe injuries that their urban and suburban counterparts.
Methods: We performed a retrospective analysis of 2006-2011 National Emergency Department Sample data to determine if mortality following trauma brain injury differs across urban/rural classifications. Emergency department (ED) visits with ICD-9-CM codes for intracranial injury (ICD-9-CM 850-854) as the primary diagnosis were included in these analyses (N = 180,499). Odds of death in the ED were calculated using multiple logistic regression analyses with patient residential urban/rural status, Injury Severity Score, comorbidities, trauma center designation, patient age, and patient gender as covariates. All analyses were performed using Stata 12.1.
Results: Residents from rural communities were 21% (p = 0.001) more likely to die of traumatic brain injury that non-rural residents, when controlling for severity, comorbidities, trauma center designation, age, and gender. Rural residents treated at Level I trauma centers were 18% (p = 0.010) more likely to die of their injuries, compared to non-rural residents. There was no statistically significant difference in mortality between rural and non-rural residents with head injury treated at Level II or Level III centers (p = 0.092 and p = 0.465, respectively). Rural residents treated for head injury at Level IV centers were 76% more likely to die compared to non-rural residents (p < 0.001).
Conclusion: People living in rural communities are significantly more likely than non-rural residents to die following traumatic brain injury. This disparity is present at Level I trauma centers and a Level IV centers, which typically serve as safety net providers in rural communities. The disparity is not present at Level II and Level III trauma centers. Distance and travel time to treatment likely play a significant role in brain injury outcomes for rural residents, but measures of distance and time were not available for these analysis. Future analyses should explore the interaction between time to treatment, level of care, and outcomes for rural residents.
