Pittsburgh Surgical Outcomes Research Center
Transforming the conduct of clinical research

Impact of the Geographic Organization of Trauma System Resources on Under-triage in Rural versus Urban Motor Vehicle Collisions

Trauma is a time-sensitive disease and rapid access to definitive care is critical. However, access to trauma care is not geographically uniform in the US. Patients injured in rural areas have worse outcomes than those injured in urban areas. The mechanisms leading to this disparity remain unclear. Under-triage may play are role which occurs when patients with serious injuries are taken to non-trauma centers. Patients who are first transported to a non-trauma center and then transferred later to a trauma center have higher mortality than those taken initially to a trauma center. Rural areas have greater variability in proximity and thus access to trauma system resources which may account for the disparity in under-triage and ultimately outcomes.

This proposal investigates how proximity and capabilities of healthcare system resources (trauma centers, medical helicopter bases, ambulance coverage, non-trauma hospitals) influence the risk of under-triage after motor vehicle collisions (MVC) in rural versus urban areas across the US. We will aggregate data at the county-level to examine the link between under-triage and mortality from a system perspective. Based our results, we will iteratively evaluate how hypothetical changes in the geographic organization of trauma system resources would impact predicted system under-triage and mortality.

This project will elucidate potential mechanisms for the disparity of rural outcomes in trauma care including why triage decisions are made, identify risk and mitigating factors for under-triage in rural areas, and develop tools to guide data-driven changes in the geospatial organization of trauma systems, reducing under-triage and improving patient outcomes.

Research Type