OUTCOMES FOLLOWING INJURY IN A PREDOMINANTLY RURAL-POPULATION-BASED TRAUMA CENTER

Objective: To determine the incidence, severity, and outcomes of injur y in patients treated in a rural-based level I trauma center and to co mpare the outcomes with a nationally indexed patient population-the Ma jor Trauma Outcome Study. Design: Retrospective evaluation of trauma r egistry data. Setting: State of Illinois designated level I trauma cen ter located in Urbana.Patients: A total of 2246 trauma patients admitt ed from August 1989 through August 1992, with a mortality cohort of 15 8 patients. There were 1735 patients (77%) with Injury Severity Scores less than or equal to 19 and 511 patients (23%) with more severe inju ries (Injury Severity Scores greater than or equal to 20). Main Outcom e Measures: Mortality rates using the TRISS method, the Major Trauma O utcome Study, and final patient dispositions. Results: The overall mor tality rate, excluding those patients who were pronounced dead on arri val, was 125/2213 (5.6%). Eighty-six (69%) of these 125 patients had n eurological Abbreviated Injury Scores of 3 or greater, with neurotraum a being a major contributer to their deaths. The m-statistic was 0.99 and the z-statistic was -3.30 for the entire group. The observed proba bility of survival met or exceeded the expected probability of surviva l when compared with the Major Trauma Outcome Study in all categories. Conclusion: Acceptable mortality rates compared with the Major Trauma Outcome Study can be achieved in a rural-community-based level I trau ma center despite relatively small numbers of critically injured patie nts. Such outcomes may assist in justifying resource allocation for tr auma centers in rural areas.