The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #71425

Tracy Young, MS¹, James Torner, MS, PhD¹, Corinne Peek-Asa, PhD¹, Alfred R. Hansen, MD, PhD², and Craig Zwerling, MD, PhD, MPH¹. (1) Injury Prevention Research Center, University of Iowa, 100 Oakdale Campus, #124 IREH, Iowa City, IA 52242, (319)335-4222, tracy-young@uiowa.edu, (2) Department of Emergency Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242

ABSTRACT

Purpose: To describe disposition from acute care hospital emergency departments (ED) in a rural community. For patients that need more than ED care, to identify factors that require transfer from rural hospitals to facilities with greater therapeutic resources versus factors that require admission to rural hospitals.

Methods: We evaluated 13,209 ED injury visits that met inclusion criteria based on disposition (admission to hospital; admission to intensive care unit or operating room; transfer from hospital; and discharge from hospital) from one of six northwest Iowa rural hospitals. We performed a bivariate analysis to depict factors related to disposition in rural hospitals. Lastly, we performed a multivariate logistic regression analysis to identify factors related to transfer from rural hospitals.

Results: We found that those under age 15 were 1.7 (95% CI = 1.1 – 2.6) times more likely to be transferred while those aged 65 and over were more likely to be admitted to a rural hospital, as were women. We also found that certain injury patterns were more or less likely to be transferred.

Conclusions: Trauma systems were primarily designed for the urban setting; little is known about rural trauma systems. An important aspect of our analysis was that we were able to examine population-based, prospective ED information in a rural setting. Further research is needed to better understand the transfer patterns in our rural trauma system, thus enabling us to measure the efficacy of our system and make refinements where needed.

Learning Objectives:

• Recognize the need for further research in rural trauma system development.
• List factors related to each of the four disposition types in acute care hospitals in a rural setting.
• List factors more or less likely to be transferred to facilities with greater therapeutic resources.

Keywords: Hospitals, Rural Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.