University of Wisconsin–Madison Medical College of Wisconsin

Trends in Mortality at a Level II Rural Trauma Center

David L. McClure, PhD; Daniel C. Cullinane, MD; Ivan L. Maldonado, MD

WMJ. 2021;120(3):178-182.

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Background: Most studies of deaths from traumatic injury are from urban trauma centers. In contrast, rural areas have higher incidence of traumatic fatal injuries than urban areas. The objective of this research was to describe trends of injuries and mortality from a trauma center serving a largely rural population and compare results with reports from the National Trauma Data Bank (NTDB).

Methods: We conducted a retrospective study of patients admitted to a rural Wisconsin level II trauma center from 2000 through 2018. Details on injuries and deaths prior to discharge were obtained from the trauma registry. Event counts and fatality ratios were described by year, sex, age, mechanism of injury, and injury severity score (ISS). Trends were analyzed across 2000-2005, 2006-2011, and 2012-2018 calendar year eras.

Results: During 2000-2018, there were 17,334 injury events among 16,495 patients included in the trauma registry. Across the 3 eras, the proportion of injuries related to falls increased (35.6%, 40.6%, and 51.5%, respectively), and the proportion from on-road motor vehicle events decreased (37.0 %, 32.8, and 22.5%, respectively), similar to the trends from 3 corresponding NTDB reports for 2004, 2010, and 2016. There was a statistically significant decreasing trend (P < 0.001) in overall fatality ratios across the 3 eras, 5.3% (95% CI, 4.7%-6.0%), 4.1% (95% CI, 3.7%-4.6%), and 3.9 (95% CI, 3.4%-4.4%), respectively. The fatality ratios point estimates were similar to overall fatality ratios from the NTDB reports (4.7%, 4.0%, 4.3%, respectively). The median patient age increased significantly from 42, 45, and 55 years across the 3 eras (test for trend P < 0.0001).

Conclusion: Long-term trends of traumatic injuries and mortality were generally similar to national trends, particularly in the shift to older patients and in the increasing proportion of injury events due to falls. Further research on traumatic injuries and deaths in rural populations is needed, particularly regarding immediate deaths at the scene and longer-term deaths after discharge.

Author Affiliations: Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin (McClure, Cullinane); Trauma Center, Marshfield Medical Center, Marshfield, Wisconsin (Maldonado).
Corresponding Author: David L. McClure, PhD, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449; phone 715.389.3036; email
Acknowledgments: The authors would like to acknowledge the following individuals: Brian Hoerneman, MD, Marshfield Medical Center; Deborah Gojmerac, BSN, RN, CSTR, Trauma Center, Marshfield Medical Center; Judith Hase, Erik Kronholm, Jennifer King, MPH, Oluwatosin Olaiya, MBChB, MSc, Edward Belongia, MD, Center for Clinical Epidemiology Population Health, Marshfield Clinic Research Institute.
Financial Disclosures: None declared.
Funding/Support: Funding for this study was provided by contributors to the Marshfield Clinic Research Institute.
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