@article{ref1,
title="Rural trauma: is trauma designation associated with better hospital outcomes?",
journal="Journal of rural health",
year="2008",
author="Bowman, Stephen M. and Zimmerman, Frederick J. and Sharar, Sam R. and Baker, Margaret W. and Martin, Diane P.",
volume="24",
number="3",
pages="263-268",
abstract="Context: While trauma designation has been associated with lower risk of death in large urban settings, relatively little attention has been given to this issue in small rural hospitals.Purpose:To examine factors related to in-hospital mortality and delayed transfer in small rural hospitals with and without trauma designation. Methods: Analysis of data from the Nationwide Inpatient Sample for discharges between 1998 and 2003 of patients hospitalized with moderate to major traumatic injury in nonfederal, short-stay rural hospitals with annual discharges of 1,500 or fewer patients (N = 9,590). Logistic regression was used to control for patient and hospital characteristics, stratifying by hospital volume. Main outcome measures were in-hospital death and transfer to another acute care facility after initial admission. Findings: A total of 333 patients (3.5%) died in-hospital. After adjusting for patient, injury and hospital characteristics, in-hospital death was more likely among patients treated at the non-designated hospitals with fewer than 500 discharges per year (OR 2.35; 95% CI 1.25-4.41) than among patients treated at similar trauma-designated hospitals. Patients admitted to non-designated hospitals were more likely to be transferred after admission, although this finding was significant only in the larger-volume hospitals with discharges of 500-1,500 per year (OR 1.41, 95% CI 1.08-1.83). Conclusions: Associations between trauma designation and outcomes in rural hospitals warrant further study to determine whether expanding designation to more rural hospitals might lead to further improvement in trauma outcomes.<p /> <p>Language: en</p>",
language="en",
issn="0890-765X",
doi="10.1111/j.1748-0361.2008.00167.x",
url="http://dx.doi.org/10.1111/j.1748-0361.2008.00167.x"
}