Differences in hospital outcomes following traumatic injury for patients experiencing immediate transfer to a level I trauma facility versus resuscitation at a critical access hospital (CAH).

Autor: Windorski J; Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA., Reyes J; Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA., Helmer SD; Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA; Department of Medical Education, Via Christi Hospital Saint Francis, Wichita, KS, USA., Ward JG; Department of Trauma Services, Chandler Regional Medical Center, Phoenix, AZ, USA., Haan JM; Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA; Trauma Services, Via Christi Hospital Saint Francis, Wichita, KS, USA. Electronic address: James.Haan.Research@ascension.org.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2019 Apr; Vol. 217 (4), pp. 643-647. Date of Electronic Publication: 2018 Nov 14.
DOI: 10.1016/j.amjsurg.2018.10.050
Abstrakt: Background: Critical access hospitals (CAH) serve a key role in providing medical care to rural patients. The purpose of this study was to assess effectiveness of CAHs in initial care of trauma patients.
Methods: A 5-year retrospective review was conducted of all adult trauma patients who were transported directly to a level I trauma facility or were transported to a CAH then transferred to a level I trauma facility after initial resuscitation.
Results: Of 1478 patients studied, 1084 were transferred from a CAH with 394 transported directly to the level I facility. Patients transported directly to the level I hospital were younger and more severely injured. After controlling for injury severity score, age, GCS, and shock, the odds of mortality did not differ between CAH transfer patients and patients transported directly to a level I facility (OR 0.70, P = 0.20). Transfer from CAH was associated with decreased ICU and hospital days, but not associated with increased ventilator days.
Conclusion: This study demonstrates that use of a CAH for initial trauma care in rural areas is effective.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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