TRAUMA DEATHS IN A MATURE URBAN VS RURAL TRAUMA SYSTEM - A COMPARISON

Objective: To compare the timing, severity, and injury characteristics of patients dying from trauma in an urban vs a rural setting. Design: Retrospective review of autopsy database (urban) and medical examiner database (rural), with selected medical. chart review. Setting: An or ganized urban trauma system with 6 trauma centers and a rural state wi th no formal trauma system and 1 trauma center. Patients: All trauma f atalities occurring in an urban (n=612) and a rural (n=143) setting du ring a 1-year period. Results: In the urban system, 248 patients (40.5 %) died at the scene of injury compared with 103 (72%) patients in a r ural environment. During the first 24 hours of hospitalization 243 (39 .7%) urban patients died compared with 23 (16%) rural patients. Eighty -nine urban patients (14.5%) and 17 rural patients (11.8%) survived fo r more than 24 hours but later died in the hospital. The mean age of t hose who died was significantly greater in the rural trauma system tha n in the urban trauma system (P<.001), and the Injury Severity Score w as significantly less in the rural trauma system than in the urban tra uma system (P<.01). In the patients who died after being admitted to t he hospital for more than 24 hours there was a significantly higher ra te of preexisting comorbidity in the rural patients than in the urban patients (P<.05). The most frequent cause of death in the rural settin g was multisystem organ failure; head injury was the most common cause of death in the urban setting. Conclusions: Patients who die in a rur al area without a formal trauma system are more likely to die at the s cene, are less severely injured, and are older. Rural trauma patients who are admitted to a hospital and who survived for at least 24 hours before dying are older, less severely injured, have significantly more comorbidities, and are more likely to die of multisystem organ dysfun ction than their urban counterparts. These differences reflect the dif ferent patient populations and injury patterns that confront urban and rural trauma centers. The higher proportion of scene deaths in the ru ral environment may reflect the longer discovery and transport times t hat occur in a rural setting.