S. C. Gale1,2, J. Peters1, P. Detwiler1, V. Y. Dombrovskiy2 1East Texas Medical Center,Trauma Surgery,Tyler, TX, USA 2Robert Wood Johnson Medical School,Rutgers University,New Brunswick, NJ, USA
Introduction:
After injury in rural settings, evaluation at local hospitals followed by transportation to regional trauma centers may cause delays to definitive care. We sought to determine if such delays impact outcomes in patients with traumatic brain injury (TBI) within a mature rural regional trauma system.
Methods:
The East Texas Medical Center Regional Level 1 Trauma registry was queried for all patients from 2008 to 2013. Blunt TBI patients, aged ≥18 and admitted ≤24 hours from injury, were stratified as “transfer” versus “direct” admission. Demographics, transfer distance, time from injury to ETMC and outcomes (mortality, complications, length of stay (LOS)) were compared for all study patients, for patients with Injury Severity Score (ISS) ≥15, and for patients requiring neurosurgical intervention using Chi-square; logistic regression was used to identify contributors to mortality.
Results:
For the 6-year study period, 7823 patients were admitted; 1845 met inclusion criteria: 947 direct admissions and 898 transfer patients from 50 different hospitals. For transfer patients, mean travel distance was 59.3±31.7 miles; mean time to Level 1 care after injury was 4.6±2.4 hours. Transfer patients were significantly older (55 vs 49 yrs p<0.01) and had more comorbidities, but also had lower mean ISS (15.9 vs 18.5 p<0.01) and lower mortality (7.0 vs 10.0% p<0.03), complications, and LOS. Neurosurgical intervention was equivalent between groups (p=0.88). For the most injured patients, those with ISS ≥15, mortality was similar (12.4 vs 14.8% p=0.28) between groups. After logistic regression analysis of all study patients, and of those with ISS ≥15, only age and ISS, not time or distance to definitive care, significantly predicted mortality.
Conclusion:
Neither transfer distance, nor transfer time, independently contributed to mortality after TBI in a rural setting utilizing staged care. An established and mature regional trauma system, with initial stabilization using ATLS principles at small, rural hospitals, is effective in reducing negative outcomes for injured patients in rural settings.