Impact of rural trauma system implementation on care of patients with spinal cord injuries

Background/Purpose: Although trauma systems have been in place in the United States for over half a century, their usefulness in rural settings has remained controversial. The mostly rural State of Iowa implemented a trauma system in 2001. This study examines the impact the new system has had on the transfer patterns of patients with spinal cord injuries (SCI).

Methods: We analyzed characteristics of spinal cord injury patients' pre-implementation (1997-1998) and post-implementation (2002-2004) and within those compared those who were transferred versus not transferred. Data were drawn from the State Trauma Registry of Iowa and spinal cord injuries were identified by ICD-9 and AIS codes. T, F, and Chi-square tests were performed to evaluate pre/post implementation and variables of transferred/not transferred, time, region where injury occurred, ISS, injury mechanism, risk of death, and level of spinal column injured.

Results/Outcome: 635 subjects were included in the analysis (235 pre-implementation (1997/1998) and 400 post-implementation (2002-2004). No significant differences were found between transfers and non-transfers in pre versus post-implementation by time, region of injury occurrence, ISS, injury mechanism, or risk of death, or level of spinal column injured. Additionally, pre and post-implementation groups did not differ significantly in terms of demographics (age, race/ethnicity, & gender).

Conclusion: The implementation of a rural trauma system did not appear to significantly impact transfer patterns of patients with spinal cord injuries. Future studies should evaluate the impact of a rural trauma system on other injury types.