Outcomes in Rural vs Urban Centre Treated Adult Trauma Patients: A Systematic Review

Author(s): Arad Khodarahmi, Yasir A. Hasan, Rahdakrishnan Nair

Introduction: With increased pressure on trauma systems, deciding whether to treat patients in rural or urban centres is crucial, yet outcomes are rarely compared. This systematic review aimed to assess outcomes in adult trauma patients treated in these settings.

Methodology: The study was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cochrane Library, EMBASE, Medline (PubMed), and CINAHL were searched for relevant English-language articles from 2014 to November 2024. Paediatric and single centre studies were excluded. Two reviewers independently screened articles and provided quality analysis of the results.

Results: From 495 screened articles, 5 high-quality studies met inclusion criteria: two from Canada and one each from Australia, USA, and Norway. All studies assessed mortality and showed inpatient mortality rates had minimal variation between rural and urban centres. 60% of studies reviewed lengths of stay (LOS), which were 1-3 days longer in urban centres. 40% looked at ICU admission rates, which were 3–15% higher in urban centres. Intensive Care Unit (ICU) LOS was reviewed by only 20% of studies and shown to be 2.2 days more in urban centres.

Conclusions: This systematic review comparing trauma outcomes between rural and urban centres found no significant difference in inpatient mortality rates, likely resulting from appropriate transfer processes in these matured trauma systems. Longer LOS, ICU LOS and higher ICU admissions rates in urban centres may reflect the treatment of more severely injured patients.