Outcomes of pediatric trauma patients transported from rural and urban scenes

Area of Science:

• Trauma surgery
• Emergency medical services
• Pediatric critical care

Background:

• Significant mortality differences are observed between urban and rural trauma victims.
• It remains unclear if these disparities persist in patients who survive to helicopter emergency medical services (HEMS) transport.
• This study investigates in-hospital outcomes for pediatric blunt trauma patients transported by HEMS from urban versus rural locations.

Purpose of the Study:

• To compare in-hospital mortality, hospital length of stay (LOS), and discharge status.
• To analyze outcomes of pediatric blunt trauma victims transported by HEMS from rural and urban scenes.
• To determine if pre-hospital factors influence survival rates.

Main Methods:

• Retrospective review of pediatric (< 17 years) HEMS transports between 1997 and 2001.
• Identification of 130 rural and 419 urban pediatric patients from HEMS and registry records.
• Comparison of patient demographics, vital signs, transport times, and in-hospital outcomes.

Main Results:

• Rural HEMS transports had significantly longer total mileage, flight times, and scene times (P < 0.05).
• No significant differences were found in age, gender, vitals, hospital/ICU days, or unadjusted mortality between urban and rural groups.
• After adjusting for Injury Severity Score (ISS) and mechanism of injury, urban patients were 9 times more likely to die than rural patients.

Conclusions:

• Pediatric patients from urban scenes experienced shorter HEMS flight and scene times compared to those from rural scenes.
• Higher adjusted in-hospital mortality in the urban group may be attributed to faster Emergency Medical Services (EMS) response and transport, minimizing out-of-hospital deaths.
• Factors preceding HEMS arrival likely play a more significant role in the increased mortality rates observed in rural blunt trauma victims nationally.