A comparison of metropolitan vs rural major trauma in Western Australia

Fatovich, Daniel M; Phillips, Michael; Langford, Stephen A.; Jacobs, Ian

doi:10.1016/j.resuscitation.2011.02.040

Cited by 79 publications

(81 citation statements)

References 19 publications

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“…An Australian study of rural areas also reported that the risk of pre‐hospital death was twofold greater in rural vs. urban areas 17. In the present study, the proportion of pre‐hospital deaths from unintentional HE trauma was markedly higher in rural areas, exceeding that found by Evans et al.…”

Section: Discussioncontrasting

confidence: 73%

“…However, that finding, applied to our data set, would have impacted less than 1% of all fatalities 21. Trauma mortality has been reported to increase in proportion with the length of EMS response time17, 22, 23, 24 and duration of hospitalization,25 although the data are controversial 26. Ultimately, the impact of transport time on mortality may be marginal, and model‐dependent 27.…”

Section: Discussionmentioning

confidence: 99%

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Fatal injuries in rural and urban areas in northern Finland: a 5‐year retrospective study

Raatiniemi

Steinvik

Liisanantti

et al. 2016

Acta Anaesthesiol Scand

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BackgroundFinland has the fourth highest injury mortality rate in the European Union. To better understand the causes of the high injury rate, and prevent these fatal injuries, studies are needed. Therefore, we set out to complete an analysis of the epidemiology of fatal trauma, and any contributory role for alcohol, long suspected to promote fatal injuries. As a study area, we chose the four northernmost counties of Finland; their mix of remote rural areas and urban centres allowed us to correlate mortality rates with ‘rurality’.MethodsThe Causes of Death Register was consulted to identify deaths from external causes over a 5‐year time period. Data were retrieved from death certificates, autopsy reports and medical records. The municipalities studied were classified as either rural or urban.ResultsOf 2915 deaths categorized as occurring from external causes during our study period, 1959 were eligible for inclusion in our study. The annual crude mortality rate was 54 per 100,000 inhabitants; this rate was higher in rural vs. urban municipalities (65 vs. 45 per 100,000 inhabitants/year). Additionally, a greater number of pre‐hospital deaths from accidental high‐energy trauma occurred in rural areas (78 vs. 69%). 42% of all pre‐hospital deaths occurred under the influence of alcohol.ConclusionThe crude mortality rate for fatal injuries was high overall as compared to other studies, and elevated in rural areas, where pre‐hospital deaths were more common. Almost half of pre‐hospital deaths occurred under the influence of alcohol.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Fatal injuries in rural and urban areas in northern Finland: a 5‐year retrospective study

Raatiniemi

Steinvik

Liisanantti

et al. 2016

Acta Anaesthesiol Scand

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“…However, the overall mortality rate did not differ between regions, a finding that contrasts with those of several prior studies. 1,3,5 The lack of a statistically significant difference in mortality may reflect a rural sample size that was underpowered to detect such a difference or inherent characteristics of the rural counties included in our sample. It is also possible that the efficiency and resources available in urban areas delay the inevitable outcome of patients with nonsurvivable injuries.…”

Section: Discussionmentioning

confidence: 97%

Evaluation of Rural vs Urban Trauma Patients Served by 9-1-1 Emergency Medical Services

Newgard

Bulger

et al. 2017

JAMA Surg

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Importance Despite a large rural US population, there are potential differences between rural and urban regions in the processes and outcomes following trauma. Objectives To describe and evaluate rural vs urban processes of care, injury severity, and mortality among injured patients served by 9-1-1 emergency medical services (EMS). Design, Setting, and Participants This was a preplanned secondary analysis of a prospective cohort enrolled from January 1 through December 31, 2011, and followed up through hospitalization. The study included 44 EMS agencies transporting to 28 hospitals in 2 rural and 5 urban counties in Oregon and Washington. A population-based, consecutive sample of 67047 injured children and adults served by EMS (1971 rural and 65 076 urban) was enrolled. Among the 53 487 patients transported by EMS, a stratified probability sample of 17 633 patients (1438 rural and 16 195 urban) was created to track hospital outcomes (78.9% with in-hospital follow-up). Data analysis was performed from June 12, 2015, to May 20, 2016. Exposures Rural was defined at the county level by 60 minutes or more driving proximity to the nearest level I or II trauma center and/or rural designation in the Centers for Medicare & Medicaid Services ambulance fee schedule by zip code. Main outcomes and Measures Mortality (out-of-hospital and in-hospital), need for early critical resources, and transfer rates. Results Of the 53 487 injured patients transported by EMS (17 633 patients in the probability sample), 27 535 were women (51.5%); mean (SD) age was 51.6 (26.1) years. Rural vs urban sensitivity of field triage for identifying patients requiring early critical resources was 65.2% vs 80.5%, and only 29.4% of rural patients needing critical resources were initially transported to major trauma centers vs 88.7% of urban patients. After accounting for transfers, 39.8% of rural patients requiring critical resources were cared for in major trauma centers vs 88.7% of urban patients. Overall mortality did not differ between rural and urban regions (1.44% vs 0.89%; P = .09); however, 89.6% of rural deaths occurred within 24 hours compared with 64% of urban deaths. Rural regions had higher transfer rates (3.2% vs 2.7%) and longer transfer distances (median, 97.4 km; interquartile range [IQR], 51.7-394.5 km; range, 47.8-398.6 km vs 22.5 km; IQR, 11.6-24.6 km; range, 3.5-97.4 km). Conclusions and Relevance Most high-risk trauma patients injured in rural areas were cared for outside of major trauma centers and most rural trauma deaths occurred early, although overall mortality did not differ between regions. There are opportunities for improved timeliness and access to major trauma care among patients injured in rural regions.

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“…10Y12, 23,24 These five studies were considered the highest quality, although their design was heterogeneous (factors contributing to this heterogeneity are discussed later). 12,23,24 A meta-analysis of these five studies (total n = 19,910) showed no difference in mortality between groups (OR for NSC vs. SC, 1.03; 95% CI, 0.85Y1.23) with a moderate level of heterogeneity (I 2 = 47%) ( Table 2 and Fig. 12,23,24 A meta-analysis of these five studies (total n = 19,910) showed no difference in mortality between groups (OR for NSC vs. SC, 1.03; 95% CI, 0.85Y1.23) with a moderate level of heterogeneity (I 2 = 47%) ( Table 2 and Fig.…”

Section: Mortality Data Traumamentioning

confidence: 99%