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J Trauma. 2009 Nov;67(5):903-9. doi: 10.1097/TA.0b013e3181aebec2.

Injuries in nonurban areas are associated with increased disability at hospital discharge.

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  • 1Division of Acute Care Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-5033, USA.



Mortality is worse after injuries occurring in rural areas. However, most trauma patients survive their injuries, and little is known about functional outcomes after nonfatal injuries that occur in rural areas compared with those that happen in the urban setting. We hypothesized that disability at hospital discharge is worse for those injured in nonurban areas.


Data from version 6.1 of the National Trauma Data Bank for patients admitted during the years 2001 to 2005 were used. Injury location data were transformed into urban influence codes by the National Trauma Data Bank administration. The independent variable was location of injury grouped into urban, suburban, and rural based on urban influence codes. The dependent variable was functional disability at hospital discharge as measured by the modified Functional Independence Measure.


Rural site of injury was associated with a worse functional outcome at hospital discharge (odds ratio [OR] = 1.27) when compared with urban site of injury. Suburban injuries were also associated with an increased risk of poor functional outcome (OR = 1.12). When fatal injuries were excluded, the magnitude of effect of location of injury was greater: rural OR = 1.52; suburban OR = 1.27.


Injuries in a nonurban location are associated with worse functional outcomes at hospital discharge. The magnitude of risk of a poor functional outcome is highest for patients who are injured in a rural location. These findings are important when considering allocation of trauma resources.

[PubMed - indexed for MEDLINE]
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