Adult minor trauma patients: Good outcome in small hospitals

Study purpose: To determine if adult minor injury trauma admissions to small hospitals have a mean length of stay (LOS) and fatality rate similar to those of admissions to larger hospitals. Population: The first 10,000 Oregon hospital trauma discharges during 1987. Exclusions were age of 17 years or younger, an Injury Severity Score (ISS) of more than 10, transfer to another health care facility, and leaving against medical advice. There were 6,739 patients meeting study criteria. Methods: This study was a retrospective cohort analysis of a hospital discharge data base. Outcome measures were LOS for survivors and fatality rate. Predictor variables included patient age, hospital bed size, Level I or II trauma facility, designation, and county population. χ² and analysis of variance were used to test significance (P<.05). Results: Two of 72 hospitals were US-government-sponsored facilities and showed a longer mean LOS (21.3 and 16.4 vs 5.5 days for all other hospitals; P<.005). Mean LOS correlated positively with patient age, ISS, and hospital bed size (P<.0001). There were 136 deaths in this low-ISS population. The fatality rate was independent of hospital size and trauma facility designation. Age was significantly greater for patients who died versus survivors (76.2 vs 49.1 years; P<.0001). Conclusion: For minor trauma patients, smaller hospitals have a shorter mean LOS and a similar fatality rate when compared with larger hospitals and Level I and II trauma facilities. Despite a low ISS, admitted elderly patients have a higher death rate regardless of hospital size.