Researchers from Oregon Health & Science University, led by Craig D. Newgard, M.D., analyzed data from 44 emergency medical services (EMS) agencies that serve 28 hospitals in seven counties in Oregon and Washington, two of which are rural counties and five of which are urban, according to a study published in JAMA Surgery. They found that in rural areas, only 29 percent of critical trauma patients were taken to a major trauma center, compared to 89 percent of urban patients, who were taken directly to level 1 or level 2 trauma centers.
The researchers also found mortality rates were about equal for urban and rural trauma care, but nine of 10 trauma deaths at rural centers occurred within 24 hours, compared to only 64 percent of urban trauma deaths. Newgard told the Portland Business Journal that this may be due in part to low thresholds at lower-level trauma centers for what necessitates a transfer to a level 1 or level 2 center.
“We may need a culture change by providers, recognizing that seriously injured patients in rural areas need to be transferred to a major trauma center more quickly,” he said.
Improved care integration between urban and rural hospitals would ensure smoother transfer processes, he said. Newgard also noted that many rural patients may opt for lower-quality care out of a desire to avoid traveling long distances to better-equipped urban or suburban trauma centers.