Study of the outcome of patients transferred to a level I hospital after stabilization at an outlying hospital in a rural setting

Objective: To determine the characteristics and outcome of transferred trau ma patients in a rural setting. Methods: We conducted a case-control study of all trauma admissions to a ru ral Level I trauma center to examine a 3.5-year (1993-1996) comparison of t rauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital, We used prehospital times, In jury Severity Score (ISS), LD50(ISS) (the ISS at which 50% of patients died ), Revised Trauma Score, probability of survival, Acute Physiology and Chro nic Health Evaluation II, and observed survival as main outcome measures. Results: RTTPs (39.4%) spent an average of 182 +/- 139 minutes at the outly ing hospital and 72 +/- 42 minutes in transport to the trauma center. Propo rtionately more head/neck and patients with multiple injuries composed the RTTP group. The RTTP were more severely injured (ISS 11.1 +/- 8.5; Acute Ph ysiology and Chronic Health Evaluation II 16.2 +/- 5.8; Revised Trauma Scor e 7.44 +/- 1.1) than the trauma patients admitted directly (ISS 7.9 +/- 5.3 ; Acute Physiology and Chronic Health Evaluation II 13.1 +/- 6.3; Revised T rauma Score 7.8 +/- 0.4; p < 0.05). However, both groups had the same LD50( ISS) (ISS = 35), When logistic regression was applied with death as the dep endent variable, both ISS and age contributed significantly (p = 0.0001) bu t transfer status did not (p = 0.473). Conclusion: Rural trauma centers admit a high percentage of RTTP, These RTT P have a higher injury severity and acuity than their trauma patients admit ted directly counterparts. Trauma care in rural areas that involves initial stabilization at outlying hospitals does not adversely affect mortality.