Geospatial analysis of severely injured rural patients in a geographically complex landscape

• Published in: Canadian Journal of Surgery 2021-12, Vol.64, p.S98-S99
• Main Authors: Dwyer, C, Strickland, M, Bradley, N, O'Dochartaigh, D, Lobay, K, Kabaroff, A, Chang, E, Widder, S, Anantha, R
• Format: Article
• Language: English
• Subjects: Mortality; Trauma
• ISSN: 0008-428X; 1488-2310

Background: Northern Alberta represents a geographically complex region encompassing over 460 000 km2. This poses substantial challenges for prehospital care of rural trauma patients. We performed a geospatial analysis to understand the geographic locations of rural trauma patients and compare those who were directly transported to a level 1 or level 2 trauma centre (Direct) with those who were initially managed in a smaller hospital and then transferred to a trauma centre (Staged). Methods: We performed a retrospective review of our trauma registry for all severely injured (Injury Severity Score [ISS] > 12) adult (> 18 yr) patients injured outside of Edmonton and admitted to a trauma centre between Jan. 1, 2016, and June 30, 2020. Clinical demographic characteristics, location, injury type and mode of transportation were compared between the Direct and Staged groups. Our primary outcome was in-hospital mortality. Results: We included 2462 patients in the study: 910 in the Direct group and 1552 in the Staged group. Patients in the Direct group were more frequently injured in motor vehicle or motorcycle collisions than patients in the Staged group (p < 0.001) and had higher ISS (20 v. 18, p < 0.05) despite having similar prehospital vital signs. Patients injured within a 60-minute drive from a trauma centre were more likely to be Direct transfer. In total, 546 (60%) (Direct) versus 729 (47%) (Staged) patients were injured within 60 minutes' driving time of a trauma centre; 14% of patients were injured more than 3 hours' driving time from a trauma centre. Significantly more patients in the Direct group required operative intervention after arrival at the trauma centre (4.3% v. 2.1%, p < 0.001). In-hospital mortality was also higher in the Direct group than in the Staged group (12% v. 8%,p < 0.001). Conclusion: Northern Alberta represents a complex landscape with a substantial number of rural patients who are injured far from a trauma centre. Higher mortality was observed in those transported directly to a trauma centre and may be accounted for by known weaknesses in this methodology. Future work will examine the impact of field triage and prehospital transportation within this graphically population. population.