PMID- 27732713 OWN - NLM STAT- MEDLINE DCOM- 20170630 LR - 20220408 IS - 2168-6262 (Electronic) IS - 2168-6254 (Print) IS - 2168-6254 (Linking) VI - 152 IP - 1 DP - 2017 Jan 1 TI - Evaluation of Rural vs Urban Trauma Patients Served by 9-1-1 Emergency Medical Services. PG - 11-18 LID - 10.1001/jamasurg.2016.3329 [doi] AB - IMPORTANCE: Despite a large rural US population, there are potential differences between rural and urban regions in the processes and outcomes following trauma. OBJECTIVES: To describe and evaluate rural vs urban processes of care, injury severity, and mortality among injured patients served by 9-1-1 emergency medical services (EMS). DESIGN, SETTING, AND PARTICIPANTS: This was a preplanned secondary analysis of a prospective cohort enrolled from January 1 through December 31, 2011, and followed up through hospitalization. The study included 44 EMS agencies transporting to 28 hospitals in 2 rural and 5 urban counties in Oregon and Washington. A population-based, consecutive sample of 67 047 injured children and adults served by EMS (1971 rural and 65 076 urban) was enrolled. Among the 53 487 patients transported by EMS, a stratified probability sample of 17 633 patients (1438 rural and 16 195 urban) was created to track hospital outcomes (78.9% with in-hospital follow-up). Data analysis was performed from June 12, 2015, to May 20, 2016. EXPOSURES: Rural was defined at the county level by 60 minutes or more driving proximity to the nearest level I or II trauma center and/or rural designation in the Centers for Medicare & Medicaid Services ambulance fee schedule by zip code. MAIN OUTCOMES AND MEASURES: Mortality (out-of-hospital and in-hospital), need for early critical resources, and transfer rates. RESULTS: Of the 53 487 injured patients transported by EMS (17 633 patients in the probability sample), 27 535 were women (51.5%); mean (SD) age was 51.6 (26.1) years. Rural vs urban sensitivity of field triage for identifying patients requiring early critical resources was 65.2% vs 80.5%, and only 29.4% of rural patients needing critical resources were initially transported to major trauma centers vs 88.7% of urban patients. After accounting for transfers, 39.8% of rural patients requiring critical resources were cared for in major trauma centers vs 88.7% of urban patients. Overall mortality did not differ between rural and urban regions (1.44% vs 0.89%; P = .09); however, 89.6% of rural deaths occurred within 24 hours compared with 64% of urban deaths. Rural regions had higher transfer rates (3.2% vs 2.7%) and longer transfer distances (median, 97.4 km; interquartile range [IQR], 51.7-394.5 km; range, 47.8-398.6 km vs 22.5 km; IQR, 11.6-24.6 km; range, 3.5-97.4 km). CONCLUSIONS AND RELEVANCE: Most high-risk trauma patients injured in rural areas were cared for outside of major trauma centers and most rural trauma deaths occurred early, although overall mortality did not differ between regions. There are opportunities for improved timeliness and access to major trauma care among patients injured in rural regions. FAU - Newgard, Craig D AU - Newgard CD AD - Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland. FAU - Fu, Rongwei AU - Fu R AD - Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland2School of Public Health, Oregon Health & Science University, Portland. FAU - Bulger, Eileen AU - Bulger E AD - Department of Surgery, University of Washington, Seattle. FAU - Hedges, Jerris R AU - Hedges JR AD - John A. Burns School of Medicine, University of Hawaii, Honolulu. FAU - Mann, N Clay AU - Mann NC AD - Intermountain Injury Control Research Center, Department of Pediatrics, University of Utah, Salt Lake City. FAU - Wright, Dagan A AU - Wright DA AD - School of Public Health, Oregon Health & Science University, Portland6Injury and Violence Prevention Section, Oregon Health Authority, Portland. FAU - Lehrfeld, David P AU - Lehrfeld DP AD - Emergency Medical Services & Trauma Systems, Oregon Health Authority, Portland. FAU - Shields, Carol AU - Shields C AD - Skamania County Emergency Medical Services, Stevenson, Washington. FAU - Hoskins, Gregory AU - Hoskins G AD - Skamania County Emergency Medical Services, Stevenson, Washington9PeaceHealth Southwest Medical Center, Vancouver, Washington. FAU - Warden, Craig AU - Warden C AD - Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland. FAU - Wittwer, Lynn AU - Wittwer L AD - Clark Regional Emergency Services Agency, Vancouver, Washington. FAU - Cook, Jennifer N B AU - Cook JN AD - Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland. FAU - Verkest, Michael AU - Verkest M AD - American Medical Response, Portland, Oregon12Clackamas County Fire District 1, Milwaukee, Oregon. FAU - Conway, William AU - Conway W AD - Clackamas County Fire District 1, Milwaukee, Oregon. FAU - Somerville, Stephanie AU - Somerville S AD - Asante Three Rivers Medical Center Trauma Program, Grants Pass, Oregon. FAU - Hansen, Matthew AU - Hansen M AD - Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland. LA - eng GR - R01 CE001837/CE/NCIPC CDC HHS/United States GR - U54 MD007584/MD/NIMHD NIH HHS/United States PT - Journal Article PL - United States TA - JAMA Surg JT - JAMA surgery JID - 101589553 SB - IM MH - Adult MH - Aged MH - Emergency Medical Services/*statistics & numerical data MH - Female MH - Health Services Accessibility MH - *Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - Oregon MH - Outcome and Process Assessment, Health Care MH - Patient Transfer/statistics & numerical data MH - Rural Population/*statistics & numerical data MH - Transportation of Patients/statistics & numerical data MH - Trauma Centers/*statistics & numerical data MH - Triage MH - Urban Population/*statistics & numerical data MH - Washington MH - Wounds and Injuries/*mortality/therapy PMC - PMC5409522 MID - NIHMS848008 COIS- Conflict of Interest Disclosures: None reported. EDAT- 2016/10/13 06:00 MHDA- 2017/07/01 06:00 PMCR- 2017/04/28 CRDT- 2016/10/13 06:00 PHST- 2016/10/13 06:00 [pubmed] PHST- 2017/07/01 06:00 [medline] PHST- 2016/10/13 06:00 [entrez] PHST- 2017/04/28 00:00 [pmc-release] AID - 2566219 [pii] AID - 10.1001/jamasurg.2016.3329 [doi] PST - ppublish SO - JAMA Surg. 2017 Jan 1;152(1):11-18. doi: 10.1001/jamasurg.2016.3329.