The Importance of Place of Residence on Hospitalized Outcomes for Severely Injured Trauma Patients: A Trauma Registry Analysis

Abstract

Purpose: Socioecological factors are understudied in relation to trauma patients' outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality.Methods: A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables.Step-wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. Findings:We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77-7.11), injury severity (HR 5.27, 95% CI: 2.78-10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06-2.09), and mechanisms related to intentional self-harm or assault (HR 2.72, 95% CI: 1.48-5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35-13.10). Increased risk for longer ALSD was evident for older age (

Increased distance or time from a major trauma centre in South Australia is not associated with worse outcomes after moderate to severe traumatic brain injury

“…Regional patients within our cohort had a median LOS almost a week longer than those from a major city. While a previous study in neighbouring New South Wales found no difference in LOS for patients with a severe TBI, 21 LOS outcomes for regional trauma patients seem to vary state‐to‐state 22 . The increased LOS identified within our cohort could be explained by limited access to rehabilitation or community services in regional areas, as well as discharge planning and transfer delays back to regional hospitals.…”

“…While a previous study in neighbouring New South Wales found no difference in LOS for patients with a severe TBI, 21 LOS outcomes for regional trauma patients seem to vary state-tostate. 22 The increased LOS identified within our cohort could be explained by limited access to rehabilitation or community services in regional areas, as well as discharge planning and transfer delays back to regional hospitals. South Australia has one brain injury rehabilitation programme available to both regional and urban patients, located within Adelaide, with the service offering a combination of community and inpatient rehabilitation.…”

“Making It Work”: A Preliminary Mixed Methods Study of Rural Trauma Care Access and Resources in New Mexico

“…While the needs of vulnerable patients in these largely urban areas cannot be dismissed, we found this first set of results surprising because it seemed to contradict previously demonstrated national trends indicating that increased distance from trauma centers negatively impacts patient outcomes [2]. This trend of poorer trauma patient outcomes at a farther distance from sites of care has been similarly observed and further validated in international settings as well [22]. In contrast to our first analysis and in line with the literature, our second analysis using CDC-WISQARS data [14], which includes all trauma fatalities (gathered from death certificates) occurring both within and outside of hospital and EMS systems, demonstrated that expected trend wherein patients living farthest from care in largely rural areas had the poorest outcomes.…”