To determine the incidence, severity, and outcomes of injury in patients treated in a rural-based level I trauma center and to compare the outcomes with a nationally indexed patient population—the Major Trauma Outcome Study.
Retrospective evaluation of trauma registry data.
State of Illinois designated level I trauma center located in Urbana.
A total of 2246 trauma patients admitted from August 1989 through August 1992, with a mortality cohort of 158 patients. There were 1735 patients (77%) with Injury Severity Scores less than or equal to 19 and 511 patients (23%) with more severe injuries (Injury Severity Scores ≥20).
Main Outcome Measures:
Mortality rates using the TRISS method, the Major Trauma Outcome Study, and final patient dispositions.
The overall mortality rate, excluding those patients who were pronounced dead on arrival, was 125/2213 (5.6%). Eighty-six (69%) of these 125 patients had neurological Abbreviated Injury Scores of 3 or greater, with neurotrauma being a major contributor to their deaths. The m-statistic was 0.99 and the z-statistic was −3.30 for the entire group. The observed probability of survival met or exceeded the expected probability of survival when compared with the Major Trauma Outcome Study in all categories.
Acceptable mortality rates compared with the Major Trauma Outcome Study can be achieved in a rural-community—based level I trauma center despite relatively small numbers of critically injured patients. Such outcomes may assist in justifying resource allocation for trauma centers in rural areas.(Arch Surg. 1994;129:800-805)