A needs assessment for regionalization of trauma care in a rural state

Systems of trauma care in urban areas have a demonstrated survival benefit. Little is known of the benefit of trauma system organization in rural areas. We hypothesized that examination of all trauma deaths during a 1-year period would provide opportunities to improve care in our rural state. We use...

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Bibliographic Details
Published in:The American surgeon 2005-08, Vol.71 (8), p.690-693
Main Authors: ROGERS, Frederick B, MADSEN, Lynn, SHACKFORD, Steven, CROOKES, Bruce, CHARASH, William, MORROW, Paul, OSLER, Turner, JAWA, Randeep, REBUCK, Jill A, IGNERI, Peter
Format: Article
Language:English
Subjects:
Biological and medical sciences
Female
General aspects
Health risk assessment
Hospitals, Rural - organization & administration
Humans
Injuries
Male
Medical Records
Medical sciences
Middle Aged
Needs Assessment
Prevention programs
Primary care
Regional Medical Programs - organization & administration
Retrospective Studies
Rural Population
Survival analysis
Trauma Centers - organization & administration
Urban areas
Vermont
Wounds and Injuries - mortality
Wounds and Injuries - prevention & control
Wounds and Injuries - therapy
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Summary:Systems of trauma care in urban areas have a demonstrated survival benefit. Little is known of the benefit of trauma system organization in rural areas. We hypothesized that examination of all trauma deaths during a 1-year period would provide opportunities to improve care in our rural state. We used a medical examiner database of trauma deaths occurring during a 1-year period. Five board-certified surgeons analyzed deaths as preventable (P), potentially preventable (PP), and non-preventable (NP) using modified Delphi technique. There were 223 trauma deaths during a 1-year period. Most (63%) died at the scene prior to any medical intervention. Adjudication of the deaths demonstrated 5 P (2%; 95% CI 1-5%), 36 PP (16%; 95% CI 12-27%), and 179 NP (81%; 95% CI 76-86%). Agreement among trauma surgeons was only moderate with a k of 0.46. Suicide accounted for a significant number of the overall trauma deaths at 32 per cent. Rural trauma system design should focus on discovery, as that is where the majority of deaths occur. Suicide is a significant problem in this rural state that should be aggressively targeted with prevention programs.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313480507100814