"We wanted to see what happened to these patients after they were injured and also to learn more about the settings in which death was most likely to occur", explained study investigator Dr. Avery B. Nathens, director of trauma services at St. Michael's and Canada Research Chair in Systems of Trauma Care.
The researchers said that interventions designed to improve the skills and resources available in rural emergency departments could reduce mortality rates from serious traumatic injury. "We also need to understand why the transfer process takes so long", Dr. Nathens added. "If we can reduce this, we can save lives."
The study found that more than half of the deaths occurred before the injured person reached a hospital emergency department (ED). These "pre-hospital" deaths were twice as likely among patients injured in the most rural locations and in those with limited access to timely trauma centre care.
"But even when people survived long enough to reach hospital, we noted a threefold increase in the risk of ED death if the injury occurred in a region with limited access to trauma centre care", stated Dr. Nathens, who is also a professor of surgery at the University of Toronto. "This means people were more likely to die before ever reaching an operating room or being admitted to hospital."
According to the data, most deaths (54 percent) occurred before any hospital contact. Motor vehicle collisions were responsible for over half of all deaths. While only 15 percent of Ontario's population lives more than one hour away from a trauma centre, this small proportion of the population accounted for 37 percent of all trauma-related deaths during the study period. This finding highlights the higher risk of death associated with delayed access to trauma centre care.
Although all patients in the study group ultimately died, the researchers considered those who succumbed to their injuries in EDs or later in hospital were "potentially salvageable", because they had potential access to life-saving interventions. Other research shows that care in a designated trauma centre is associated with a 25 percent lower risk of death among severely injured patients. Ontario has nine designated Level I adult trauma centres, all located in urban areas.
But delivering timely, appropriate trauma care is a challenge in Ontario, where 90 percent of the province is considered rural, said Dr. Nathens. In Ontario, there is no requirement that smaller, more rural hospitals have a trauma team to assist in providing early care to stabilize severely injured patients such that they can survive long enough to benefit from the highest level of trauma care available in trauma centres. Nor do Ontario hospitals require that emergency department staff in these smaller centres have any special training in the treatment of severely injured patients.
St. Michael's is partnering with the Ontario Telemedicine network to evaluate the usefulness of telemedicine in helping community hospitals deliver better early care to severely injured patients.
The new study, entitled "Identifying Targets for Potential Interventions to Reduce Rural Trauma Deaths: A Population-Based Analysis", has been published on-line in the Journal of Trauma.
St. Michael's Hospital provides compassionate care to all who walk through its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing Knowledge Institute, research at St. Michael's Hospital is recognized and put into practice around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.