PMID- 7832343 OWN - NLM STAT- MEDLINE DCOM- 19950217 LR - 20191210 IS - 0196-0644 (Print) IS - 0196-0644 (Linking) VI - 25 IP - 2 DP - 1995 Feb TI - Stabilization of rural multiple-trauma patients at level III emergency departments before transfer to a level I regional trauma center. PG - 175-81 AB - STUDY OBJECTIVE: To determine whether triage and stabilization of severely injured rural trauma victims in outlying Level III emergency departments before transfer to Level I trauma centers results in outcomes similar to national normative data. DESIGN: Retrospective review of trauma transfers and deaths during a 4-year period. SETTING: Two Level III EDs in rural, upstate New York and an urban Level I regional trauma center. PARTICIPANTS: Fifty multiple-trauma victims with a Trauma Triage Score (T-RTS) of < or = 11 or less. Forty-three patients were stabilized before transfer, and 7 died in the rural Level III ED. RESULTS: There were 45 blunt injuries and 5 penetrating injuries. Mean patient age was 34 years (range, 9 months to 97 years). The Revised Trauma Score (RTS) on admission to the Level III ED was calculated for each patient (median score, 5.97; interquartile range (IQR), 4.09 to 6.90), as was the ultimate Injury Severity Score (ISS) (median score, 23; IQR, 13 to 29). With TRISS methodology, probabilities of survival (Ps) and death (Pd) were calculated. Results were compared with the Major Trauma Outcome Study (MTOS) by use of current coefficients derived from Walker-Duncan regression analysis of MTOS data. The predicted number of deaths was 13.5, whereas the actual number was 12, Z statistic, -.710. There were two unexpected survivors and three unexpected deaths. The 43 patients who were stabilized and transferred had a median RTS of 5.97 (IQR, 4.30 to 6.90) and an ISS of 18 (IQR, 12 to 25). The median interval in the Level III ED before transfer was 1 hour 43 minutes (IQR, 1 hour 11 minutes to 2 hours 40 minutes). There were two unexpected survivors (Ps = .32, Ps = .49) and 1 unexpected death (Ps = .52). The predicted number of deaths was 8.1, whereas the actual number was 5. The 7 patients who died in the rural Level III ED had a median RTS of 4.41 (IQR, 2.98 to 4.71) and a median ISS of 50 (IQR, 44 to 65). The median interval in the Level III ED before death was 42 minutes (IQR, 41 minutes to 1 hour 20 minutes). There were 2 unexpected deaths (Ps = .66, Ps = .55). The predicted number of deaths was 5.4 whereas the actual number was 7. CONCLUSION: Triage and stabilization of severely injured rural trauma victims at Level III EDs before Level I transfer provide outcomes similar to national results. Unexpected death of severely injured trauma victims remains a problem in rural Level III EDs. FAU - Veenema, K R AU - Veenema KR AD - Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, NY. FAU - Rodewald, L E AU - Rodewald LE LA - eng PT - Journal Article PL - United States TA - Ann Emerg Med JT - Annals of emergency medicine JID - 8002646 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Child MH - Child, Preschool MH - Emergency Service, Hospital/*standards MH - Female MH - Hospitals, Rural/*standards MH - Humans MH - Infant MH - Male MH - Middle Aged MH - Multiple Trauma/*therapy MH - New York MH - *Outcome Assessment, Health Care MH - *Patient Transfer MH - Retrospective Studies MH - Transportation of Patients MH - Trauma Centers MH - Trauma Severity Indices MH - Triage/methods/standards EDAT- 1995/02/01 00:00 MHDA- 1995/02/01 00:01 CRDT- 1995/02/01 00:00 PHST- 1995/02/01 00:00 [pubmed] PHST- 1995/02/01 00:01 [medline] PHST- 1995/02/01 00:00 [entrez] AID - S0196-0644(95)70320-9 [pii] AID - 10.1016/s0196-0644(95)70320-9 [doi] PST - ppublish SO - Ann Emerg Med. 1995 Feb;25(2):175-81. doi: 10.1016/s0196-0644(95)70320-9.