OBJECTIVE To determine the proportion and characteristics of injured rural residents treated at urban trauma centers (TCs), urban non-trauma centers (NTCs), rural TCs, and rural NTCs. SUMMARY BACKGROUND DATA Timely treatment at a designated trauma center improves outcomes for patients with serious injuries, but rural residents have limited access to designated trauma centers. Rural non-trauma centers may constitute an underrecognized source of trauma care. METHODS We used the National Emergency Department Sample to conduct a retrospective, pooled cross-sectional study of ED visits among rural residents with injury severity score (ISS) ≥ 9 (indicating at least moderate injury). Hospitals were designated as a trauma (TC) or non-trauma center (NTC) and as rural or urban. We compared management, disposition, and outcomes among hospital types. RESULTS Of 748,587 injured rural residents from 2016-2020, 384,113 (51.3%) were treated in rural NTCs, 232,845 (31.1%) in urban TCs, 116,493 (15.6%) in urban NTCs, and 15,137 (2.0%) in rural TCs. Injuries treated at rural NTCs were moderate in severity (ISS 9-15) in 76.6% of visits, severe (ISS 16-25) in 15.7%, and very severe (ISS > 25) in 1.1%. Urban TCs saw the highest proportion of very severe injuries (17.3%). Rural NTCs managed 77.5% of visits definitively, discharging 72.8%. They transferred 21.9% of patients. Length of stay was longest and hospital charges highest for patients treated in urban TCs, which also performed the most procedures. Rural NTCs had the shortest length of stay and lowest mean charges. CONCLUSIONS Rural non-trauma centers provided initial care for more than half of injured rural residents, including 2 in 5 of those with the most severe injuries, and managed more than 3 in 4 definitively. These hospitals may be an under-recognized component of the US trauma system.

中文翻译：

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服务不足的地理：农村非创伤医院对创伤护理的贡献。


目的 了解城市创伤中心（TC）、城市非创伤中心（NTC）、农村创伤中心和农村非创伤中心治疗的农村居民受伤的比例和特征。摘要背景数据 在指定的创伤中心及时治疗可以改善重伤患者的治疗效果，但农村居民进入指定创伤中心的机会有限。农村非创伤中心可能是一个未被充分认识的创伤护理来源。方法 我们使用国家急诊室样本对伤害严重程度评分 (ISS) ≥ 9（表明至少为中度伤害）的农村居民的急诊就诊情况进行回顾性、汇总横断面研究。医院被指定为创伤（TC）或非创伤中心（NTC）以及农村或城市医院。我们比较了不同类型医院的管理、处置和结果。结果 2016-2020年，748,587名受伤农村居民中，384,113人（51.3%）在农村伤病中心接受治疗，232,845人（31.1%）在城市伤病中心接受治疗，116,493人（15.6%）在城市伤病中心接受治疗，15,137人（2.0%）在农村伤病中心接受治疗。在农村 NTC 接受治疗的伤害中，76.6% 的就诊率为中度（ISS 9-15），15.7% 为重度（ISS 16-25），1.1% 为极重度（ISS > 25）。城市TC的重伤比例最高（17.3%）。农村 NTC 最终管理了 77.5% 的访问量，释放了 72.8%。他们转移了 21.9% 的患者。在城市TC接受治疗的患者的住院时间最长，住院费用也最高，这些TC也进行了最多的手术。农村 NTC 的停留时间最短，平均收费最低。结论 农村非创伤中心为一半以上受伤的农村居民提供了初步护理，其中五分之二的伤势最严重，并最终对四分之三以上的人进行了治疗。 这些医院可能是美国创伤系统中未被充分认识的组成部分。