Short-term outcome and differences between rural and urban trauma patients treated by mobile intensive care units in Northern Finland: a retrospective analysis.

Lasse Raatiniemi,Seppo Alahuhta,Pasi Ohtonen,Matti Martikainen,Heini Nal,Suvi Niemi,Harri Antikainen,Janne Liisanantti

doi:10.1186/s13049-015-0175-2

Abstract

BackgroundEmergency medical services are an important part of trauma care, but data comparing urban and rural areas is needed. We compared 30-day mortality and length of intensive care unit (ICU) stay for trauma patients injured in rural and urban municipalities and collected basic data on trauma care in Northern Finland.MethodsWe examined data from all trauma patients treated by the Finnish Helicopter Emergency Medical Services in 2012 and 2013. Only patients surviving to hospital were included in the analysis but all pre-hospital deaths were recorded. All data was retrieved from the national Helicopter Emergency Medical Services database, medical records, and the Finnish Causes of Death Registry. Patients were defined as urban or rural depending on the type of municipality where the injury occurred.ResultsA total of 472 patients were included. Age and Injury Severity Score did not differ between rural and urban patients. The pre-hospital time intervals and distances to trauma centers were longer for rural patients and a larger proportion of urban patients had intentional injuries (23.5 % vs. 9.3 %, P <0.001). The 30-day mortality for severely injured patients (Injury Severity Score >15) was 23.9 % in urban and 13.3 % in rural municipalities. In the multivariate regression analysis the odds ratio (OR) for 30-day mortality was 2.8 (95 % confidence interval 1.0 to 7.9, P = 0.05) in urban municipalities. There was no difference in the length of ICU stay or scores. Twenty patients died on scene or during transportation and 56 missions were aborted because of pre-hospital death.ConclusionsThe severely injured urban trauma patients had a trend toward higher 30-day mortality compared with patients injured in rural areas but the length of ICU stay was similar. However, more pre-hospital deaths occurred in rural municipalities. The time before mobile ICU arrival appears to be critical for trauma patients’ survival, especially in rural areas.

Highlights

Emergency medical services are an important part of trauma care, but data comparing urban and rural areas is needed
We aimed to describe the incidence, demographics, and critical care of trauma patients treated by the Finnish helicopter emergency medical services (HEMS) (FinnHEMS) units in Northern Finland
Patients and injuries A total of 558 trauma patients were treated by FinnHEMS during the study period, accounting for 29.3 % (558/1904) of all patients examined

Summary

Introduction

Emergency medical services are an important part of trauma care, but data comparing urban and rural areas is needed. We compared 30-day mortality and length of intensive care unit (ICU) stay for trauma patients injured in rural and urban municipalities and collected basic data on trauma care in Northern Finland. Trauma systems have been shown to reduce mortality and improve long-term outcomes [2, 3] but early recognition and rapid transportation of seriously injured patients directly to trauma centers are crucial factors in pre-hospital trauma care [4, 5]. Trauma is the most common cause of dispatch of helicopter emergency medical services (HEMS) in Scandinavia [6]. Distances to definitive care in geographically large Northern Finland can be very long and it is unknown whether outcomes differ between patients injured in rural vs urban locations

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