Study of the Outcome of Patients Transferred to a Level I Hospital after Stabilization at an Outlying Hospital in a Rural Setting
OBJECTIVETo determine the characteristics and outcome of transferred trauma patients in a rural setting. METHODSWe conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those tra...
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| Veröffentlicht in: | The Journal of Trauma: Injury, Infection, and Critical Care Infection, and Critical Care, 1999-02, Vol.46 (2), p.328-333 |
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| container_title | The Journal of Trauma: Injury, Infection, and Critical Care |
| container_volume | 46 |
| creator | Rogers, Frederick B. Osler, Turner M. Shackford, Steven R. Cohen, Myra Camp, Lorelei Lesage, Margaret |
| description | OBJECTIVETo determine the characteristics and outcome of transferred trauma patients in a rural setting.
METHODSWe conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital. We used prehospital times, Injury Severity Score (ISS), LD50ISS (the ISS at which 50% of patients died), Revised Trauma Score, probability of survival, Acute Physiology and Chronic Health Evaluation II, and observed survival as main outcome measures.
RESULTSRTTPs (39.4%) spent an average of 182 +/- 139 minutes at the outlying hospital and 72 +/- 42 minutes in transport to the trauma center. Proportionately more head/neck and patients with multiple injuries composed the RTTP group. The RTTP were more severely injured (ISS 11.1 +/- 8.5; Acute Physiology and Chronic Health Evaluation II 16.2 +/- 5.8; Revised Trauma Score 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 Trauma Score 7.8 +/- 0.4; p < 0.05). However, both groups had the same LD50ISS (ISS = 35). When logistic regression was applied with death as the dependent variable, both ISS and age contributed significantly (p = 0.0001) but transfer status did not (p = 0.473).
CONCLUSIONRural trauma centers admit a high percentage of RTTP. These RTTP have a higher injury severity and acuity than their trauma patients admitted directly counterparts. Trauma care in rural areas that involves initial stabilization at outlying hospitals does not adversely affect mortality. |
| doi_str_mv | 10.1097/00005373-199902000-00022 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69590961</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69590961</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3852-b27f1f4d761572e5d2e944715bc5a7f9263b9d42c14516f400b48291eeeada573</originalsourceid><addsrcrecordid>eNp1kk1v3CAQhlGVqlml-QsVhyg3t4DBmGMV5UtaKVE3PSNsD11U1mwBJ9re-s-Lu5uPS5EQM8wzM2heEMKUfKZEyS-kLFHLuqJKKcKKV5XN2Du0oIKpqm2JOkKL-aoSrGXH6DQl182MkIq1H9AxLbYinC3Qn1Wehh0OFuc14Lsp92EDs3tvsoMxJ_wQzZgsxAgDzgEbvIRH8PgW34S0ddl4bGyGiFfZdM673yUvjNhkbMa5nt-58ccr60oIf5tiMVeQc4l9RO-t8QlOD-cJ-n51-XBxUy3vrm8vvi6rvm4FqzomLbV8kA0VkoEYGCjOJRVdL4y0ijV1pwbOesoFbSwnpOMtUxQAzGCErE_Q-b7uNoZfE6SsNy714L0ZIUxJN0ooohpawHYP9jGkFMHqbXQbE3eaEj0roJ8V0C8K6H8KlNRPhx5Tt4HhTeJ-3gU4OwAm9cbbMtvepVeuUW1N57fyPfYUfJlt-umnJ4h6Dcbntf7fB6j_Ar7RnTw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69590961</pqid></control><display><type>article</type><title>Study of the Outcome of Patients Transferred to a Level I Hospital after Stabilization at an Outlying Hospital in a Rural Setting</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Rogers, Frederick B. ; Osler, Turner M. ; Shackford, Steven R. ; Cohen, Myra ; Camp, Lorelei ; Lesage, Margaret</creator><creatorcontrib>Rogers, Frederick B. ; Osler, Turner M. ; Shackford, Steven R. ; Cohen, Myra ; Camp, Lorelei ; Lesage, Margaret</creatorcontrib><description>OBJECTIVETo determine the characteristics and outcome of transferred trauma patients in a rural setting.
METHODSWe conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital. We used prehospital times, Injury Severity Score (ISS), LD50ISS (the ISS at which 50% of patients died), Revised Trauma Score, probability of survival, Acute Physiology and Chronic Health Evaluation II, and observed survival as main outcome measures.
RESULTSRTTPs (39.4%) spent an average of 182 +/- 139 minutes at the outlying hospital and 72 +/- 42 minutes in transport to the trauma center. Proportionately more head/neck and patients with multiple injuries composed the RTTP group. The RTTP were more severely injured (ISS 11.1 +/- 8.5; Acute Physiology and Chronic Health Evaluation II 16.2 +/- 5.8; Revised Trauma Score 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 Trauma Score 7.8 +/- 0.4; p < 0.05). However, both groups had the same LD50ISS (ISS = 35). When logistic regression was applied with death as the dependent variable, both ISS and age contributed significantly (p = 0.0001) but transfer status did not (p = 0.473).
CONCLUSIONRural trauma centers admit a high percentage of RTTP. These RTTP have a higher injury severity and acuity than their trauma patients admitted directly counterparts. Trauma care in rural areas that involves initial stabilization at outlying hospitals does not adversely affect mortality.</description><identifier>ISSN: 0022-5282</identifier><identifier>EISSN: 1529-8809</identifier><identifier>DOI: 10.1097/00005373-199902000-00022</identifier><identifier>PMID: 10029042</identifier><identifier>CODEN: JOTRA5</identifier><language>eng</language><publisher>Baltimore, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; APACHE ; Biological and medical sciences ; Case-Control Studies ; Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine ; Female ; Hospitals, Community ; Hospitals, Rural ; Humans ; Intensive care medicine ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Multiple Trauma - classification ; Multiple Trauma - mortality ; Multiple Trauma - therapy ; Outcome Assessment (Health Care) ; Patient Transfer - standards ; Survival Analysis ; Trauma Centers ; Trauma Severity Indices ; Triage - standards ; Vermont - epidemiology</subject><ispartof>The Journal of Trauma: Injury, Infection, and Critical Care, 1999-02, Vol.46 (2), p.328-333</ispartof><rights>1999 Lippincott Williams & Wilkins, Inc.</rights><rights>1999 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3852-b27f1f4d761572e5d2e944715bc5a7f9263b9d42c14516f400b48291eeeada573</citedby><cites>FETCH-LOGICAL-c3852-b27f1f4d761572e5d2e944715bc5a7f9263b9d42c14516f400b48291eeeada573</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,780,784,789,790,23930,23931,25140,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1698317$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10029042$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rogers, Frederick B.</creatorcontrib><creatorcontrib>Osler, Turner M.</creatorcontrib><creatorcontrib>Shackford, Steven R.</creatorcontrib><creatorcontrib>Cohen, Myra</creatorcontrib><creatorcontrib>Camp, Lorelei</creatorcontrib><creatorcontrib>Lesage, Margaret</creatorcontrib><title>Study of the Outcome of Patients Transferred to a Level I Hospital after Stabilization at an Outlying Hospital in a Rural Setting</title><title>The Journal of Trauma: Injury, Infection, and Critical Care</title><addtitle>J Trauma</addtitle><description>OBJECTIVETo determine the characteristics and outcome of transferred trauma patients in a rural setting.
METHODSWe conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital. We used prehospital times, Injury Severity Score (ISS), LD50ISS (the ISS at which 50% of patients died), Revised Trauma Score, probability of survival, Acute Physiology and Chronic Health Evaluation II, and observed survival as main outcome measures.
RESULTSRTTPs (39.4%) spent an average of 182 +/- 139 minutes at the outlying hospital and 72 +/- 42 minutes in transport to the trauma center. Proportionately more head/neck and patients with multiple injuries composed the RTTP group. The RTTP were more severely injured (ISS 11.1 +/- 8.5; Acute Physiology and Chronic Health Evaluation II 16.2 +/- 5.8; Revised Trauma Score 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 Trauma Score 7.8 +/- 0.4; p < 0.05). However, both groups had the same LD50ISS (ISS = 35). When logistic regression was applied with death as the dependent variable, both ISS and age contributed significantly (p = 0.0001) but transfer status did not (p = 0.473).
CONCLUSIONRural trauma centers admit a high percentage of RTTP. These RTTP have a higher injury severity and acuity than their trauma patients admitted directly counterparts. Trauma care in rural areas that involves initial stabilization at outlying hospitals does not adversely affect mortality.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>APACHE</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine</subject><subject>Female</subject><subject>Hospitals, Community</subject><subject>Hospitals, Rural</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multiple Trauma - classification</subject><subject>Multiple Trauma - mortality</subject><subject>Multiple Trauma - therapy</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patient Transfer - standards</subject><subject>Survival Analysis</subject><subject>Trauma Centers</subject><subject>Trauma Severity Indices</subject><subject>Triage - standards</subject><subject>Vermont - epidemiology</subject><issn>0022-5282</issn><issn>1529-8809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kk1v3CAQhlGVqlml-QsVhyg3t4DBmGMV5UtaKVE3PSNsD11U1mwBJ9re-s-Lu5uPS5EQM8wzM2heEMKUfKZEyS-kLFHLuqJKKcKKV5XN2Du0oIKpqm2JOkKL-aoSrGXH6DQl182MkIq1H9AxLbYinC3Qn1Wehh0OFuc14Lsp92EDs3tvsoMxJ_wQzZgsxAgDzgEbvIRH8PgW34S0ddl4bGyGiFfZdM673yUvjNhkbMa5nt-58ccr60oIf5tiMVeQc4l9RO-t8QlOD-cJ-n51-XBxUy3vrm8vvi6rvm4FqzomLbV8kA0VkoEYGCjOJRVdL4y0ijV1pwbOesoFbSwnpOMtUxQAzGCErE_Q-b7uNoZfE6SsNy714L0ZIUxJN0ooohpawHYP9jGkFMHqbXQbE3eaEj0roJ8V0C8K6H8KlNRPhx5Tt4HhTeJ-3gU4OwAm9cbbMtvepVeuUW1N57fyPfYUfJlt-umnJ4h6Dcbntf7fB6j_Ar7RnTw</recordid><startdate>199902</startdate><enddate>199902</enddate><creator>Rogers, Frederick B.</creator><creator>Osler, Turner M.</creator><creator>Shackford, Steven R.</creator><creator>Cohen, Myra</creator><creator>Camp, Lorelei</creator><creator>Lesage, Margaret</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199902</creationdate><title>Study of the Outcome of Patients Transferred to a Level I Hospital after Stabilization at an Outlying Hospital in a Rural Setting</title><author>Rogers, Frederick B. ; Osler, Turner M. ; Shackford, Steven R. ; Cohen, Myra ; Camp, Lorelei ; Lesage, Margaret</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3852-b27f1f4d761572e5d2e944715bc5a7f9263b9d42c14516f400b48291eeeada573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>APACHE</topic><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine</topic><topic>Female</topic><topic>Hospitals, Community</topic><topic>Hospitals, Rural</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multiple Trauma - classification</topic><topic>Multiple Trauma - mortality</topic><topic>Multiple Trauma - therapy</topic><topic>Outcome Assessment (Health Care)</topic><topic>Patient Transfer - standards</topic><topic>Survival Analysis</topic><topic>Trauma Centers</topic><topic>Trauma Severity Indices</topic><topic>Triage - standards</topic><topic>Vermont - epidemiology</topic><toplevel>online_resources</toplevel><creatorcontrib>Rogers, Frederick B.</creatorcontrib><creatorcontrib>Osler, Turner M.</creatorcontrib><creatorcontrib>Shackford, Steven R.</creatorcontrib><creatorcontrib>Cohen, Myra</creatorcontrib><creatorcontrib>Camp, Lorelei</creatorcontrib><creatorcontrib>Lesage, Margaret</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of Trauma: Injury, Infection, and Critical Care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rogers, Frederick B.</au><au>Osler, Turner M.</au><au>Shackford, Steven R.</au><au>Cohen, Myra</au><au>Camp, Lorelei</au><au>Lesage, Margaret</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Study of the Outcome of Patients Transferred to a Level I Hospital after Stabilization at an Outlying Hospital in a Rural Setting</atitle><jtitle>The Journal of Trauma: Injury, Infection, and Critical Care</jtitle><addtitle>J Trauma</addtitle><date>1999-02</date><risdate>1999</risdate><volume>46</volume><issue>2</issue><spage>328</spage><epage>333</epage><pages>328-333</pages><issn>0022-5282</issn><eissn>1529-8809</eissn><coden>JOTRA5</coden><abstract>OBJECTIVETo determine the characteristics and outcome of transferred trauma patients in a rural setting.
METHODSWe conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital. We used prehospital times, Injury Severity Score (ISS), LD50ISS (the ISS at which 50% of patients died), Revised Trauma Score, probability of survival, Acute Physiology and Chronic Health Evaluation II, and observed survival as main outcome measures.
RESULTSRTTPs (39.4%) spent an average of 182 +/- 139 minutes at the outlying hospital and 72 +/- 42 minutes in transport to the trauma center. Proportionately more head/neck and patients with multiple injuries composed the RTTP group. The RTTP were more severely injured (ISS 11.1 +/- 8.5; Acute Physiology and Chronic Health Evaluation II 16.2 +/- 5.8; Revised Trauma Score 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 Trauma Score 7.8 +/- 0.4; p < 0.05). However, both groups had the same LD50ISS (ISS = 35). When logistic regression was applied with death as the dependent variable, both ISS and age contributed significantly (p = 0.0001) but transfer status did not (p = 0.473).
CONCLUSIONRural trauma centers admit a high percentage of RTTP. These RTTP have a higher injury severity and acuity than their trauma patients admitted directly counterparts. Trauma care in rural areas that involves initial stabilization at outlying hospitals does not adversely affect mortality.</abstract><cop>Baltimore, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>10029042</pmid><doi>10.1097/00005373-199902000-00022</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy APACHE Biological and medical sciences Case-Control Studies Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine Female Hospitals, Community Hospitals, Rural Humans Intensive care medicine Logistic Models Male Medical sciences Middle Aged Multiple Trauma - classification Multiple Trauma - mortality Multiple Trauma - therapy Outcome Assessment (Health Care) Patient Transfer - standards Survival Analysis Trauma Centers Trauma Severity Indices Triage - standards Vermont - epidemiology |
| title | Study of the Outcome of Patients Transferred to a Level I Hospital after Stabilization at an Outlying Hospital in a Rural Setting |
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