Tran Quincy K, Ternovskaia Anastasia, Downing Jessica V, Cheema Minahil, Kowansky Taylor, Vashee Isha, Sayal Jasjot, Wu Jasmine, Singh Aditi, Haase Daniel J
Department of Emergency Medicine University of Maryland School of Medicine, Baltimore, MD, USA.
The R Adams Cowley Shock Trauma Center University of Maryland School of Medicine, Baltimore, MD, USA.
Crit Care Res Pract. 2024 Aug 22;2024:9599855. doi: 10.1155/2024/9599855. eCollection 2024.
Previous research suggests that patients from rural areas who are critically ill with complex medical needs or require time-sensitive subspecialty interventions face worse healthcare outcomes and delays in care when compared to those from urban areas. The critical care resuscitation unit (CCRU) at our quaternary care center was established to expedite the transfer of critically ill patients or those who need time-sensitive intervention. This study investigates if disparities exist in treatments and outcomes among patients transferred to the CCRU from rural versus urban hospitals.
This is a retrospective study of adult, nontrauma patients admitted to the CCRU via interhospital transfer from outside facilities from January 1 to December 31, 2018. Patients transferred from within our institution or with missing clinical data were excluded. Multivariable logistic regressions were performed to measure the association between patients' demographic and clinical factors with in-hospital mortality.
We analyzed 1381 nontrauma patients, and 484 (35%) were from rural areas. Median age was 59 [47-69], and 629 (46%) were female. Median sequential organ failure assessment was 3 ([1-6], =0.062) for both patients transferred from urban and rural hospitals. There was no significant difference between groups with respect to most demographic and clinical factors, as well as types of interventions after CCRU arrival, including emergent surgical interventions within 12 hours of arrival at the CCRU. Rural patients were more likely to be transferred for care by the acute care emergency surgery service than were patients from urban areas and were transferred over a significantly greater distance (difference of 53 kilometers (km), 95% CI: -58.9-51.7 km, < 0.001). Transfer from rural areas was not associated with increased odds of in-hospital mortality (OR: 0.90, 95% CI: 0.60, 1.36; =0.63).
Thirty-five percent of patients transferred to the CCRU came from rural areas, which house 25% of the state population of Maryland. Patients transferred from rural counties to the CCRU faced greater transport distances, but they received the same level of care upon arrival at the CCRU and had the same odds of in-hospital mortality as patients transferred from urban hospitals.
先前的研究表明，与城市地区的患者相比，患有复杂医疗需求的重症农村患者或需要及时进行专科干预的患者面临更差的医疗结果和护理延迟。我们的四级医疗中心设立了重症监护复苏单元（CCRU），以加快重症患者或需要及时干预的患者的转运。本研究调查了从农村医院与城市医院转入CCRU的患者在治疗和结局方面是否存在差异。
这是一项对2018年1月1日至12月31日期间通过院际转运从外部机构转入CCRU的成年非创伤患者的回顾性研究。排除从本机构内部转入或临床数据缺失的患者。进行多变量逻辑回归分析，以衡量患者的人口统计学和临床因素与院内死亡率之间的关联。
我们分析了1381例非创伤患者，其中484例（35%）来自农村地区。中位年龄为59岁[47 - 69岁]，629例（46%）为女性。从城市和农村医院转入的患者的序贯器官衰竭评估中位数均为3（[1 - 6]，P = 0.062）。在大多数人口统计学和临床因素以及CCRU到达后的干预类型方面，两组之间没有显著差异，包括在到达CCRU后12小时内进行的急诊手术干预。与城市地区的患者相比，农村患者更有可能由急性护理急诊手术服务转诊接受治疗，并且转诊距离明显更远（相差53公里（km），95%置信区间：-58.9 - 51.7 km，P < 0.001）。从农村地区转诊与院内死亡几率增加无关（比值比：0.90，95%置信区间：0.60，1.36；P = 0.63）。
转入CCRU的患者中有35%来自农村地区，而农村地区人口占马里兰州总人口的25%。从农村县转入CCRU的患者面临更长的转运距离，但他们到达CCRU后接受的护理水平相同，且院内死亡几率与从城市医院转入的患者相同。
