WMJ Vol 120 Issue 3: Trends in Mortality at a Level II Rural Trauma Center

ABSTRACT

Background: Most studies of deaths from traumatic injury are from urban trauma centers. In contrast, rural areas have higher incidence of traumatic fatal injuries than urban areas. The objective of this research was to describe trends of injuries and mortality from a trauma center serving a largely rural population and compare results with reports from the National Trauma Data Bank (NTDB).

Methods: We conducted a retrospective study of patients admitted to a rural Wisconsin level II trauma center from 2000 through 2018. Details on injuries and deaths prior to discharge were obtained from the trauma registry. Event counts and fatality ratios were described by year, sex, age, mechanism of injury, and injury severity score (ISS). Trends were analyzed across 2000-2005, 2006-2011, and 2012-2018 calendar year eras.

Results: During 2000-2018, there were 17,334 injury events among 16,495 patients included in the trauma registry. Across the 3 eras, the proportion of injuries related to falls increased (35.6%, 40.6%, and 51.5%, respectively), and the proportion from on-road motor vehicle events decreased (37.0 %, 32.8, and 22.5%, respectively), similar to the trends from 3 corresponding NTDB reports for 2004, 2010, and 2016. There was a statistically significant decreasing trend (P < 0.001) in overall fatality ratios across the 3 eras, 5.3% (95% CI, 4.7%-6.0%), 4.1% (95% CI, 3.7%-4.6%), and 3.9 (95% CI, 3.4%-4.4%), respectively. The fatality ratios point estimates were similar to overall fatality ratios from the NTDB reports (4.7%, 4.0%, 4.3%, respectively). The median patient age increased significantly from 42, 45, and 55 years across the 3 eras (test for trend P < 0.0001).

Conclusion: Long-term trends of traumatic injuries and mortality were generally similar to national trends, particularly in the shift to older patients and in the increasing proportion of injury events due to falls. Further research on traumatic injuries and deaths in rural populations is needed, particularly regarding immediate deaths at the scene and longer-term deaths after discharge.

Target Audience

The target audience for this journal-based activity is healthcare providers caring for the people and communities of Wisconsin and beyond.

Learning Objectives

As a result of this journal-based activity, learners will be able to:

  1. Explain the long-term trends of traumatic injuries and mortality among patients who were admitted to a rural level II trauma center.
  2. Discuss the relevance of the study findings to the learner’s clinical practice.
  3. Interpret the need for further research on traumatic injuries and deaths in rural populations stated in the article.
    Course summary
    Available credit: 
    • 1.00 AMA PRA Category 1 Credit
    • 1.00 ANCC Contact Hours
    • 1.00 University of Wisconsin–Madison Continuing Education Hours
      • 1.00 Approved for AMA PRA Category 1 Credit™
    Registration opens: 
    03/17/2022
    Course expires: 
    03/16/2023
    Cost:
    $0.00
    Rating: 
    0

    FACULTY DISCLOSURE

    It is the policy of the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) to identify, mitigate and disclose all relevant financial relationships with ineligible companies* held by the  speakers/presenters, authors, planners, and other persons who may influence content of this accredited continuing education (CE).  In addition, speakers, presenters and authors must disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation.

    For this accredited continuing education activity all relevant financial relationships have been mitigated and detailed disclosures are listed below.

    Name of IndividualIndividual's Role in Activity

    Name of Commercial Interest &
    Nature of Relationship

    Discussion of
    Unlabeled/Unapproved
    Uses of Drugs/Devices
    in Presentation?

    Marianna Shershneva, MD, PhDAccreditation SpecialistNo relevant relationships with ineligible companies to discloseNo
    David L. McClure, PhDAuthorNo relevant relationships with ineligible companies to discloseNo
    Daniel C. Cullinane, MDAuthorNo relevant relationships with ineligible companies to discloseNo
    Ivan L. Maldonado, MDAuthorNo relevant relationships with ineligible companies to discloseNo
    Yana Puckett, MDReviewerNo relevant relationships with ineligible companies to discloseNo
    Ryan J. Wagner, MDReviewerNo relevant relationships with ineligible companies to discloseNo
    Nainika Nanda, MDReviewerNo relevant relationships with ineligible companies to discloseNo
    Robert Treat, PhDEditorNo relevant relationships with ineligible companies to discloseNo

    *Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on, patients.

    The ACCME does not consider providers of clinical services directly to patients to be ineligible companies.

    Discloser List CME Internal Report

    Accreditation

    Accreditation Statement

    Jointly Accredited Provider LogoIn support of improving patient care, this activity has been planned and implemented by the University of Wisconsin–Madison ICEP and the Wisconsin Medical Journal.  The University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


    Credit Designation Statements

    American Medical Association (AMA)

    The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Continuing Education Units

    The University of Wisconsin–Madison ICEP, as a member of the University Professional & Continuing Education Association (UPCEA), authorizes this program for 0.1 continuing education units (CEUs) or 1 hour.

    Available Credit

    • 1.00 AMA PRA Category 1 Credit
    • 1.00 ANCC Contact Hours
    • 1.00 University of Wisconsin–Madison Continuing Education Hours
      • 1.00 Approved for AMA PRA Category 1 Credit™

    Price

    Cost:
    $0.00
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