The incidence of severe trauma in small rural hospitals.

Trauma is the third leading cause of death in the United States, and yet relatively little is known about its epidemiology, especially in rural areas. A retrospective study was done in five Washington and Idaho communities to determine the incidence of severe trauma seen in small rural hospitals. Records were reviewed for the year 1983 on all trauma patients (565 cases) who were either admitted to or transferred from these hospitals. The study area included five hospitals and 30 physicians, serving a population of 57,600 people over 7,396 square miles. Each patient's injuries were rated according to the Injury Severity Score (ISS), a standardized trauma index. Of the cases reviewed, 3.4 percent of the cases had an ISS greater than or equal to 20, reflecting severe multisystem trauma, 14.7 percent had an ISS of 10 to 19, ie, severe trauma limited to one body system or multisystem trauma of a less-critical nature. There were 30 patients (5.3 percent) with critical head injuries, 24 patients (4.2 percent) with major chest injuries, and 21 patients (3.7 percent) with serious abdominal injuries. The results showed that each individual physician or hospital did not see the severe cases often, but that when they occurred, these types of injuries necessitated an experienced, rapid response on the part of the hospital staff. This finding has significant implications for trauma management in rural communities.