Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117857

Hope Tiesman, MSPH¹, Tracy Young, MS², and James Torner, MS, PhD². (1) Department of Epidemiology, University of Iowa, 100 Oakdale Campus, Iowa City, IA 52242, 319-621-2983, hope-tiesman@uiowa.edu, (2) Injury Prevention Research Center, University of Iowa, 100 Oakdale Campus, #124 IREH, Iowa City, IA 52242

Purpose: While the success of trauma systems in metropolitan areas has been established, their benefit in rural settings is uncertain. Timely arrival at definitive care is critical for persons with traumatic brain injuries (TBI's) since damage can occur over the following hours and days. We analyzed data from the Iowa System Trauma Registry to measure the system effects of an inclusive trauma system in a rural setting.

Methods: Two years of data prior to implementation of the trauma system (1997-1998) were compared to two years after full implementation (2002-2003). Included were 710 pre-trauma system TBI's and 886 TBI's occurring post-trauma system obtained from nine Iowa Trauma Registry Hospitals. TBI's were classified into high, moderate, and low death risk using a combination of physiologic criteria and severity measures. Univariate statistics were calculated to compare system effects.

Results: Before trauma system implementation, trauma hospitals patient mix included 19% low-risk TBI's, 39% moderate-risk, and 40% high-risk; however, after implementation, the patient mix changed to include 16% low-risk TBI's, 39% moderate-risk, and 44% high-risk. Post-implementation, high-risk TBI's were more likely to arrive in the emergency room DOA (p<0.001) and more likely to have a length of stay beyond 15 days (p=0.003). In addition, those with moderate TBI's were more likely to die within 72 hours (p=0.029).

Conclusions: Implementation of the trauma system shifted the more seriously injured patients to level I and level 2 trauma centers. Further research is needed to better understand transfer patterns and outcomes in this rural trauma system.

Learning Objectives:

Step
• Describe the Iowa System Trauma Registry Step
• Understand how a rural trauma system changes the system efffects in a rural setting. Step
• Understand how a rural trauma system affects traumatic brain injury outcomes.

Keywords: Rural Populations, Traumatic Brain Injury

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.