A comparison of metropolitan vs rural major trauma in Western Australia

Background: Metropolitan and rural Western Australia (WA) major trauma transport times are extremely different. We compared outcomes from these different systems of care. Methods: 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. Results: 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 11.6 h, 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). Conclusion: 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. (C) 2011 Elsevier Ireland Ltd. All rights reserved.