News: ‘Golden hour’ treatment rarely achieved for trauma patients in rural areas
Treatment for trauma patients in rural areas of Montana far exceeded the “golden hour” of care, a study published in The American Journal or Emergency Medicine recently found. Patients experienced delays in definitive care, averaging at seven-hour transfers over 188 miles, and those with severe injuries had an increased risk of mortality.
The “golden hour” is used to represent a critical period following traumatic injury when timely definitive care is essential for survival. Although most United States residents live within an hour of a Level I or II trauma center, rural populations face greater challenges in accessing such care within the “golden hour.”
Researchers conducted a retrospective, single-center study examining 4,213 trauma activations at a Level I trauma center in Montana and surrounding rural areas from 2012 to 2022. Patients considered in the study were those admitted to tertiary centers directly from the scene and those transferred from other facilities to tertiary centers. Patients were excluded if they lacked documented injury time, had an Injury Severity Score (ISS) of 75, or transfer times exceeding 48 hours.
Compared to patients admitted directly to the scene, the study found that patients transferred from other facilities had:
- Higher unadjusted mortality rates (5.0% vs 3.0%; P < .0001)
- higher mean ISSs (14.5 vs 8.3; P < .0001)
- Longer hospital stays (6.0 vs 3.0 days; P < .0001)
- Longer ICU stays (4.6 vs 3.7 days; P = .0045)
In addition, patients transferred from other facilities also reached the tertiary center much later and traveled much further than those admitted directly from the scene. Transfer status was also not found to be an independent predictor of survival. Patients with an ISS < 15 had higher odds of survival than those with an ISS ≥ 15.
Most (81.4%) transfers originated from small or isolated rural towns with limited surgical coverage. Isolated rural facilities were far less likely than urban facilities to have on-call surgeons and instead relied more heavily on advanced practice providers.
Patients' odds of survival decreased by 5% for every additional year of age and for each one-point increase in ISS. Odds of survival were found to be positively associated with longer hospital length of stay and negatively associated with a higher shock index.
"Rural trauma patients experience significant delays in access to definitive care. Enhancing resources and trauma training for rural providers, particularly advanced practice providers, may mitigate outcome disparities across geographically underserved regions. Further regional studies are needed to reduce time to definitive care," the authors wrote.
Editor’s note: To read the full study, click here. To read additional coverage of this study from Medscape Medical News, click here.