A Needs Assessment for Regionalization of Trauma Care in a Rural State

Rogers, Frederick B.; Madsen, Lynn; Shackford, Steven; Crookes, Bruce; Charash, William; Morrow, Paul; Osler, Turner; Jawa, Randeep; Rebuck, Jill A.; Igneri, Peter
August 2005
American Surgeon;Aug2005, Vol. 71 Issue 8, p690
Academic Journal
Systems of trauma care in urban areas have a demonstrated survival benefit. Little is known of the benefit of trauma system organization in rural areas. We hypothesized that examination of all trauma deaths during a 1-year period would provide opportunities to improve care in our rural state. We used a medical examiner database of trauma deaths occurring during a 1-year period. Five board-certified surgeons analyzed deaths as preventable (P), potentially preventable (PF), and nonpreventable (NP) using modified Delphi technique. There were 223 trauma deaths during a 1-year period. Most (63%) died at the scene prior to any medical intervention. Adjudication of the deaths demonstrated 5 P (2%; 95% CI 1-5%), 36 PP (16%; 95% CI 12-27%), and 179 NP (81%; 95% CI 76-86%). Agreement among trauma surgeons was only moderate with a k of 0.46. Suicide accounted for a significant number of the overall trauma deaths at 32 per cent. Rural trauma system design should focus on discovery, as that is where the majority of deaths occur. Suicide is a significant problem in this rural state that should be aggressively targeted with prevention programs.


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