The Importance of Place of Residence on Hospitalized Outcomesfor Severely Injured Trauma Patients: A Trauma Registry Analysis
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Author(s)
Heathcote, Katharine
Wullschleger, Martin
Gardiner, Ben
Morgan, GEoffrey
Barbagello, Holly
Sun, Jing
Sun, Jing
Griffith University Author(s)
Year published
2019
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Purpose: Socioecological factors are understudied in relation to trauma patients’ outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality.
Methods: A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step‐wise multivariable negative binomial regression and proportional hazards regression analyses were ...
View more >Purpose: Socioecological factors are understudied in relation to trauma patients’ outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality. Methods: A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step‐wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. Findings: We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77‐7.11), injury severity (HR 5.27, 95% CI: 2.78‐10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06‐2.09), and mechanisms related to intentional self‐harm or assault (HR 2.72, 95% CI: 1.48‐5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35‐13.10). Increased risk for longer ALSD was evident for older age (RR 1.35, 95% CI: 1.07‐1.71), head injury (RR 1.39, 95% CI: 1.19‐1.62), extremity injuries (RR 1.82, 95% CI: 1.55‐2.14), and higher injury severity scores (ISS) (RR 1.51, 95%: CI: 1.29‐1.76). Conclusions: Severely injured rural trauma patients are more likely to be socioeconomically disadvantaged and sustain injuries predisposing them to worse hospital outcomes. Further research is needed to understand more about care pathways and factors influencing the severity, mechanism and clinical consequences of rural‐based traumatic injuries.
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View more >Purpose: Socioecological factors are understudied in relation to trauma patients’ outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality. Methods: A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step‐wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. Findings: We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77‐7.11), injury severity (HR 5.27, 95% CI: 2.78‐10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06‐2.09), and mechanisms related to intentional self‐harm or assault (HR 2.72, 95% CI: 1.48‐5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35‐13.10). Increased risk for longer ALSD was evident for older age (RR 1.35, 95% CI: 1.07‐1.71), head injury (RR 1.39, 95% CI: 1.19‐1.62), extremity injuries (RR 1.82, 95% CI: 1.55‐2.14), and higher injury severity scores (ISS) (RR 1.51, 95%: CI: 1.29‐1.76). Conclusions: Severely injured rural trauma patients are more likely to be socioeconomically disadvantaged and sustain injuries predisposing them to worse hospital outcomes. Further research is needed to understand more about care pathways and factors influencing the severity, mechanism and clinical consequences of rural‐based traumatic injuries.
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Journal Title
The Journal of Rural Health
Copyright Statement
© 2019 National Rural Health Association. This is the peer reviewed version of the following article: The Importance of Place of Residence on Hospitalized Outcomesfor Severely Injured Trauma Patients: A Trauma Registry Analysis, The Journal of Rural Health, which has been published in final form at 10.1111/jrh.12407. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
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This publication has been entered into Griffith Research Online as an Advanced Online Version.
Subject
Nursing
Health services and systems
Public health
Other health sciences
Development studies