Citation

Rogers FB, Madsen L, Shackford S, Crookes B, Charash W, Morrow P, Osler T, Jawa R, Rebuck JA, Igneri P. Am. Surg. 2005; 71(8): 690-693.

Affiliation

Department of Surgery-Division of Trauma, University of Vermont College of Medicine, Burlington, Vermont, USA.

Copyright

(Copyright © 2005, Southeastern Surgical Congress)

DOI

unavailable

PMID

16217954

Abstract

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 nonpreventable (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.