Far from Home: Patient preferences and acceptable risk tolerance for local vs regional trauma care

Regionalization of trauma care can improve outcomes but may conflict with patient preferences and risk tolerance. This study analyzed trauma patients' preferences for local care across different risk profiles.

Structured surveys and modified standard gamble utility assessments were conducted with trauma inpatients to gauge additional operative risks they would accept for local versus regional care. Logistic and mixed model regressions identified predictors of willingness to accept these risks.

Of 112 patients, 88 ​% and 89 ​% preferred local care when complication and mortality risks were identical to the regional center. When local risk was 2 ​% higher, 28 ​% and 36 ​% still preferred local care. Patients with blunt injuries were more likely to prefer local care. On average, patients accepted 3 ​% additional complication and mortality risk for local care.

Patient preference and risk tolerance are crucial for designing trauma systems, as many prefer local care even at increased risks.