Traumatic brain injury: outcomes of a rural versus urban population over a 5 year period

Abstract

Problem: The death rate from trauma in rural regions is disproportionately high compared to urban areas. In order to establish guidelines and quality assurance measures for Traumatic Brain Injury (TBI) patients in Hawaii, it is necessary to understand their characteristics and demographics. Methods: Data on TBI injuries in Hawaii from 1999-2004 was obtained from 2 separate data sources: The Queen's Medical Center Trauma Database and the administrative data of the largest insurer for the state of Hawaii. The sample was composed of those patients diagnosed with TBI treated at any hospital in the state of Hawaii. Mortality rates during hospitalization for patients transferred from rural areas were compared using chi-square tests and logistic regression analysis Results: There were 3447 patients treated at Queen's Medical Center and 1050 patients in the Insurance Company's database who were treated during the same interval. Our findings confirm that male gender, alcohol use and lack of protective I devices result in higher rates of head injury. Fatalities from TBI were highest in young adults and the elderly. Although rates of injury were higher in rural locations, mortality rates were not significantly different. Conclusions: TBI is a major cause hospitalization in Hawaii. The greatest potential to reduce morbidity and mortality would result if preventive strategies were aimed at the highest risk groups.