Stabilization of Rural Multiple-Trauma Patients at Level III Emergency Departments Before Transfer to a Level I Regional Trauma Center, ,

Study objective: To determine whether triage and stabilization of severely injured rural trauma victims in outlying Level III emergency departments before transfer to Level I trauma centers results in outcomes similar to national normative data. Design: Retrospective review of trauma transfers and deaths during a 4-year period. Setting: Two Level III EDs in rural, upstate New York and an urban Level I regional trauma center. Participants: Fifty multiple-trauma victims with a Trauma Triage Score (T-RTS) of ≤11 or less. Forty-three patients were stabilized before transfer, and 7 died in the rural Level III ED. Results: There were 45 blunt injuries and 5 penetrating injuries. Mean patient age was 34 years (range, 9 months to 97 years). The Revised Trauma Score (RTS) on admission to the Level III ED was calculated for each patient (median score, 5.97; interquartile range (IQR), 4.09 to 6.90), as was the ultimate Injury Severity Score (ISS) (median score, 23; IQR, 13 to 29). With TRISS methodology, probabilities of survival (Ps) and death (Pd) were calculated. Results were compared with the Major Trauma Outcome Study (MTOS) by use of current coefficients derived from Walker-Duncan regression analysis of MTOS data. The predicted number of deaths was 13.5, whereas the actual number was 12, Z statistic, –.7l0. There were two unexpected survivors and three unexpected deaths. The 43 patients who were stabilized and transferred had a median RTS of 5.97 (IQR, 4.30 to 6.90) and an ISS of 18 (IQR, 12 to 25). The median interval in the Level III ED before transfer was 1 hour 43 minutes (IQR, 1 hour 11 minutes to 2 hours 40 minutes). There were two unexpected survivors (Ps=.32, Ps=.49) and 1 unexpected death (Ps=.52). The predicted number of deaths was 8.1, whereas the actual number was 5. The 7 patients who died in the rural Level III ED had a median RTS of 4.41 (IQR, 2.98 to 4.71) and a median ISS of 50 (IQR, 44 to 65). The median interval in the Level III ED before death was 42 minutes (IQR, 41 minutes to 1 hour 20 minutes). There were 2 unexpected deaths (Ps=.66, Ps=.55). The predicted number of deaths was 5.4 whereas the actual number was 7. Conclusion: Triage and stabilization of severely injured rural trauma victims at Level III EDs before Level I transfer provide outcomes similiar to national results. Unexpected death of severely injured trauma victims remains a problem in rural Level III EDs. [Veenema KR, Rodewald LE: Stabilization of rural multiple-trauma patients at Level III emergency departments before transfer to a Level I regional trauma center. Ann Emerg Med February 1995;25:175-181.]