This study compared the trauma outcome between urban and suburban hospitals. The medical records of patients admitted to the intensive care unit (ICU) following trauma, obtained from 1994 to 1995 and 2002 to 2003, were examined. One was a tertiary university teaching hospital with regional emergency medical center (EMC), and the other was a small general hospital in a suburban area. Since 1999, the suburban hospital has enlarged its capacities to include EMC. In this study, the standardizing W (Ws), 95% confidence interval (CI) of Ws, and the predicted survival rate (Ps) were calculated using the Trauma and Injury Severity Score (TRISS) method. From 1994 to 1995, 225 and 121 records of the urban and suburban hospital were reviewed, respectively. The performance of trauma care in the urban hospital was more accurate than that in the suburban (95% CI of the Ws in urban and small suburban hospital:-2.30 to 2.73 and -11.40 to -5.90, respectively). The actual survival rate of the suburban hospital was significantly lower than the predicted survival rate at all revised trauma score (RTS). From 2002 to 2003, 315 and 268 medical records of urban and suburban hospital were reviewed, respectively. The 95% CI of the Ws in urban and suburban hospital was -3.56 to 0.24 and -3.73 to 0.26, respectively. In addition, there were no differences in the distribution of actual survival rate that was compared with the predicted survival rate according to injury severity score (ISS) and RTS in each hospital. After increasing the capacity of the suburban hospital, the trauma care performance was more accurate, and the ability of the physiologic support had improved. In addition, a larger suburban hospital could manage more severely injured patients without the need for transfer (mean ISS from 1994-1995 to 2002-2003: 21.0 vs. 24.3, p = 0.059, mean RTS: 7.0 and 6.2, p = 0.003; transfer:admission ratio = 0.182:0.056, respectively, p = 0.01). In conclusion, under the well-constructed emergency medical service system, the enlargement of the capacities of emergency and intensive care should improve the performance of trauma care in suburban hospital.
- Trauma outcome
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