Abstract
BackgroundFarming is a high risk occupation that predisposes workers to injury, but may also lead to barriers in reaching trauma care. Little is known about emergency and trauma care for patients with farm-related injuries. The purpose of this study was to determine whether severely injured farmers presenting to a statewide trauma system faced delays in reaching definitive care compared to other severely injured workers.MethodsA population-based observational study was performed using the Iowa State Trauma Registry from 2005 to 2011. The registry was used to identify a multiply imputed sample of severe occupational injuries. Time to definitive care for farm- and non-farm-related injuries was compared using Kaplan-Meier curves and an extended, stratified Cox model censoring at 4 h. An interaction with time was included in the Cox model to generate hazard ratios for each hour after injury.ResultsSeven-hundred forty-eight severe occupational injuries were identified; 21% of these were farm-related. The overall median time to definitive care was nearly an hour longer for farmers compared to other workers (2h46m vs. 1h48m, p < 0.05). When adjusted for confounders, farm status remained a significant predictor of delay in reaching definitive care, but only in the first hour after injury (HR = 0.44, 95%CI = 0.24–0.83).ConclusionsFarm-related injuries accounted for more than 1 of every 5 severe occupational injuries entered into the Iowa trauma system. We found that severely injured farmers had delays in reaching definitive trauma care, even when adjusted for confounding variables such as rurality. This effect was most pronounced in the first hour.
Highlights
Farming is a high risk occupation that predisposes workers to injury, but may lead to barriers in reaching trauma care
Trauma systems arose from a need to provide care for the numerous injuries that occur among the general population, and evidence suggests that such systems have been beneficial at a population level
While the implementation of the Oregon trauma system resulted in a decreased risk of death on a state-level (Mullins and Mann 1998), the same benefit could not be replicated in a remote rural sample from the same state (Mann et al 2001)
Summary
Farming is a high risk occupation that predisposes workers to injury, but may lead to barriers in reaching trauma care. The results of a recent meta-analysis of 6 population-based studies (2020) 7:33 indicated that trauma system implementation was associated with an estimated 15% reduction in mortality (Celso et al 2006). Despite this improvement in outcomes, the benefits may not have been realized in all populations. While the implementation of the Oregon trauma system resulted in a decreased risk of death on a state-level (adjusted OR = 0.80, CI95% = 0.70–0.91) (Mullins and Mann 1998), the same benefit could not be replicated in a remote rural sample from the same state (Mann et al 2001)
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