August 1994

Outcomes Following Injury in a Predominantly Rural-Population—Based Trauma Center

Author Affiliations

From the Trauma Services, East Texas Medical Center, Tyler (Dr Norwood) and the Carle Foundation Hospital, Urbana, Ill (Ms Myers).

Arch Surg. 1994;129(8):800-805. doi:10.1001/archsurg.1994.01420320022003

Objective:  To determine the incidence, severity, and outcomes of injury in patients treated in a rural-based level I trauma center and to compare the outcomes with a nationally indexed patient population—the Major Trauma Outcome Study.

Design:  Retrospective evaluation of trauma registry data.

Setting:  State of Illinois designated level I trauma center located in Urbana.

Patients:  A total of 2246 trauma patients admitted from August 1989 through August 1992, with a mortality cohort of 158 patients. There were 1735 patients (77%) with Injury Severity Scores less than or equal to 19 and 511 patients (23%) with more severe injuries (Injury Severity Scores ≥20).

Main Outcome Measures:  Mortality rates using the TRISS method, the Major Trauma Outcome Study, and final patient dispositions.

Results:  The overall mortality rate, excluding those patients who were pronounced dead on arrival, was 125/2213 (5.6%). Eighty-six (69%) of these 125 patients had neurological Abbreviated Injury Scores of 3 or greater, with neurotrauma being a major contributor to their deaths. The m-statistic was 0.99 and the z-statistic was −3.30 for the entire group. The observed probability of survival met or exceeded the expected probability of survival 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 trauma center despite relatively small numbers of critically injured patients. Such outcomes may assist in justifying resource allocation for trauma centers in rural areas.(Arch Surg. 1994;129:800-805)