STABILIZATION OF RURAL MULTIPLE-TRAUMA PATIENTS AT LEVEL-III EMERGENCY-DEPARTMENTS BEFORE TRANSFER TO A LEVEL-I REGIONAL-TRAUMA-CENTER

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) oi III 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 (P-s) and death (P-d) 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 (P-s=.32, P-s=.49) and 1 unexpected death (P-s=.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 (P-s=.66, P-s=.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.