A comparison of metropolitan vs rural major trauma in Western Australia.

Abstract

Metropolitan and rural Western Australia (WA) major trauma transport times are extremely different. We compared outcomes from these different systems of care. Major trauma (Injury Severity Score, ISS>15) data from the Royal Flying Doctor Service (RFDS) and Trauma Registries, 1 July 1997-30 June 2006. Two groups were studied: Metro (metropolitan major trauma transported directly to a tertiary hospital), and Rural (rural major trauma transferred by the RFDS to a tertiary hospital in Perth). The primary endpoint was death. We used logistic regression and multiple imputation. 3333 major trauma patients were identified (mean age 40.1 ± 22.6 yrs; Metro=2005, Rural=1328). The rural patients were younger, had a larger proportion of motor vehicle crashes, and higher median ISS (25 vs 24, p<0.001). Mean times to definitive care were 59 min versus 11.6h, respectively (p<0.0001). After adjusting for age, injury severity and the effect of time with the initial rural deaths, there was a significantly increased risk of death (OR 2.60, 95% CI 1.05-6.53, p=0.039) in the Rural group. For those rural patients who reached Perth, the adjusted OR for death was 1.10 (95% CI 0.66-1.84, p=0.708). There is more than double the risk of major trauma death in rural and remote WA. However, if a major trauma patient survives to be retrieved to Perth by the RFDS, then mortality outcomes are equivalent to the metropolitan area.