RT Journal Article
SR Electronic
T1 Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 123
OP 130
DO 10.1503/cjs.004218
VO 62
IS 2
A1 Gavin Tansley
A1 Nadine Schuurman
A1 Matthew Bowes
A1 Mete Erdogan
A1 Robert Green
A1 Mark Asbridge
A1 Natalie Yanchar
YR 2019
UL http://canjsurg.ca/content/62/2/123.abstract
AB Background: Trauma is a leading contributor to the burden of disease in Canada, accounting for more than 15 000 deaths annually. Although caring for injured patients at designated trauma centres (TCs) is consistently associated with survival benefits, it is unclear how travel time to definitive care influences outcomes. Using a population-based sample of trauma patients, we studied the association between predicted travel time (PTT) to TCs and mortality for patients assigned to ground transport.Methods: Victims of penetrating trauma or motor vehicle collisions (MVCs) in Nova Scotia between 2005 and 2014 were identified from a provincial trauma registry. We conducted cost distance analyses to quantify PTT for each injury location to the nearest TC. Adjusted associations between TC access and injury-related mortality were then estimated using logistic regression.Results: Greater than 30 minutes of PTT to a TC was associated with a 66% increased risk of death for MVC victims (p = 0.045). This association was lost when scene deaths were excluded from the analysis. Sustaining a penetrating trauma greater than 30 minutes from a TC was associated with a 3.4-fold increase in risk of death. Following the exclusion of scene deaths, this association remained and approached significance (odds ratio 3.48, 95% confidence interval 0.98–14.5, p = 0.053).Conclusion: Predicted travel times greater than 30 minutes were associated with worse outcomes for victims of MVCs and penetrating injuries. Improving communication across the trauma system and reducing prehospital times may help optimize outcomes for rural trauma patients.