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Short-term outcome and differences between rural and urban trauma patients treated by mobile intensive care units in Northern Finland: a retrospective analysis.

Raatiniemi L, Liisanantti J, Niemi S, Nal H, Ohtonen P, Antikainen H, Martikainen M, Alahuhta S - Scand J Trauma Resusc Emerg Med (2015)

Bottom Line: Age and Injury Severity Score did not differ between rural and urban patients.Twenty patients died on scene or during transportation and 56 missions were aborted because of pre-hospital death.However, more pre-hospital deaths occurred in rural municipalities.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Intensive Care, Lapland Central Hospital, Rovaniemi, Finland. lasse.raatiniemi@gmail.com.

ABSTRACT

Background: Emergency medical services are an important part of trauma care, but data comparing urban and rural areas is needed. We compared 30-day mortality and length of intensive care unit (ICU) stay for trauma patients injured in rural and urban municipalities and collected basic data on trauma care in Northern Finland.

Methods: We examined data from all trauma patients treated by the Finnish Helicopter Emergency Medical Services in 2012 and 2013. Only patients surviving to hospital were included in the analysis but all pre-hospital deaths were recorded. All data was retrieved from the national Helicopter Emergency Medical Services database, medical records, and the Finnish Causes of Death Registry. Patients were defined as urban or rural depending on the type of municipality where the injury occurred.

Results: A total of 472 patients were included. Age and Injury Severity Score did not differ between rural and urban patients. The pre-hospital time intervals and distances to trauma centers were longer for rural patients and a larger proportion of urban patients had intentional injuries (23.5% vs. 9.3%, P <0.001). The 30-day mortality for severely injured patients (Injury Severity Score >15) was 23.9% in urban and 13.3% in rural municipalities. In the multivariate regression analysis the odds ratio (OR) for 30-day mortality was 2.8 (95% confidence interval 1.0 to 7.9, P = 0.05) in urban municipalities. There was no difference in the length of ICU stay or scores. Twenty patients died on scene or during transportation and 56 missions were aborted because of pre-hospital death.

Conclusions: The severely injured urban trauma patients had a trend toward higher 30-day mortality compared with patients injured in rural areas but the length of ICU stay was similar. However, more pre-hospital deaths occurred in rural municipalities. The time before mobile ICU arrival appears to be critical for trauma patients' survival, especially in rural areas.

No MeSH data available.


Related in: MedlinePlus

Flow chart of the study participants
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Fig1: Flow chart of the study participants

Mentions: A total of 558 trauma patients were treated by FinnHEMS during the study period, accounting for 29.3 % (558/1904) of all patients examined. Twenty trauma patients (3.6 %) died in the pre-hospital setting. We included a final total of 472 patients in the analysis (Fig. 1). The characteristics of the patients who survived to hospital are presented in Table 1. Injuries were classified as severe in 33.1 % (156/472) of cases with most patients suffering blunt injuries. We found no significant differences between the rural and urban groups regarding age, sex, ISS score, or ASA-PS scores (Table 1). Traffic accidents were the most common type of unintentional injuries, and intentional injuries were more common in urban municipalities.Fig. 1


Short-term outcome and differences between rural and urban trauma patients treated by mobile intensive care units in Northern Finland: a retrospective analysis.

Raatiniemi L, Liisanantti J, Niemi S, Nal H, Ohtonen P, Antikainen H, Martikainen M, Alahuhta S - Scand J Trauma Resusc Emerg Med (2015)

Flow chart of the study participants
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4635532&req=5

Fig1: Flow chart of the study participants
Mentions: A total of 558 trauma patients were treated by FinnHEMS during the study period, accounting for 29.3 % (558/1904) of all patients examined. Twenty trauma patients (3.6 %) died in the pre-hospital setting. We included a final total of 472 patients in the analysis (Fig. 1). The characteristics of the patients who survived to hospital are presented in Table 1. Injuries were classified as severe in 33.1 % (156/472) of cases with most patients suffering blunt injuries. We found no significant differences between the rural and urban groups regarding age, sex, ISS score, or ASA-PS scores (Table 1). Traffic accidents were the most common type of unintentional injuries, and intentional injuries were more common in urban municipalities.Fig. 1

Bottom Line: Age and Injury Severity Score did not differ between rural and urban patients.Twenty patients died on scene or during transportation and 56 missions were aborted because of pre-hospital death.However, more pre-hospital deaths occurred in rural municipalities.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Intensive Care, Lapland Central Hospital, Rovaniemi, Finland. lasse.raatiniemi@gmail.com.

ABSTRACT

Background: Emergency medical services are an important part of trauma care, but data comparing urban and rural areas is needed. We compared 30-day mortality and length of intensive care unit (ICU) stay for trauma patients injured in rural and urban municipalities and collected basic data on trauma care in Northern Finland.

Methods: We examined data from all trauma patients treated by the Finnish Helicopter Emergency Medical Services in 2012 and 2013. Only patients surviving to hospital were included in the analysis but all pre-hospital deaths were recorded. All data was retrieved from the national Helicopter Emergency Medical Services database, medical records, and the Finnish Causes of Death Registry. Patients were defined as urban or rural depending on the type of municipality where the injury occurred.

Results: A total of 472 patients were included. Age and Injury Severity Score did not differ between rural and urban patients. The pre-hospital time intervals and distances to trauma centers were longer for rural patients and a larger proportion of urban patients had intentional injuries (23.5% vs. 9.3%, P <0.001). The 30-day mortality for severely injured patients (Injury Severity Score >15) was 23.9% in urban and 13.3% in rural municipalities. In the multivariate regression analysis the odds ratio (OR) for 30-day mortality was 2.8 (95% confidence interval 1.0 to 7.9, P = 0.05) in urban municipalities. There was no difference in the length of ICU stay or scores. Twenty patients died on scene or during transportation and 56 missions were aborted because of pre-hospital death.

Conclusions: The severely injured urban trauma patients had a trend toward higher 30-day mortality compared with patients injured in rural areas but the length of ICU stay was similar. However, more pre-hospital deaths occurred in rural municipalities. The time before mobile ICU arrival appears to be critical for trauma patients' survival, especially in rural areas.

No MeSH data available.


Related in: MedlinePlus