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Profile of trauma mortality and trauma care resources at rural emergency departments and urban trauma centres in Quebec: a population-based, retrospective cohort study
  1. Richard Fleet1,2,
  2. François Lauzier3,4,
  3. Fatoumata Korinka Tounkara2,
  4. Stéphane Turcotte5,
  5. Julien Poitras6,
  6. Judy Morris7,
  7. Mathieu Ouimet8,
  8. Jean-Paul Fortin9,
  9. Jeff Plant10,
  10. France Légaré11,
  11. Gilles Dupuis12,
  12. Catherine Turgeon-Pelchat2
  1. 1Médecine familiale et médecine d’urgence, Universite Laval, Quebec, Canada
  2. 2Centre de recherche du CISSS Chaudière-Appalaches, Chaire de recherche en médecine d’urgence ULaval - CISSS Chaudière-Appalaches, Lévis, Canada
  3. 3Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec - Université Laval, Quebec, Canada
  4. 4Department of Anesthesiology and Critical Care Medicine, Universite Laval, Quebec, Canada
  5. 5Centre de recherche du CISSS Chaudière-Appalaches, CISSS Chaudière-Appalaches, Lévis, Canada
  6. 6Faculty of Medicine, Université Laval, Québec, Canada
  7. 7Emergency Medicine department, HSCM, Montreal, Canada
  8. 8Sciences politiques, Universite Laval, Quebec, Canada
  9. 9Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec, Canada
  10. 10Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
  11. 11Family and Emergency Medicine, Université Laval, Québec, Canada
  12. 12Psychology, Université du Québec à Montréal, Montreal, Canada
  1. Correspondence to Dr Richard Fleet; Richard.Fleet{at}


Objectives As Canada’s second largest province, the geography of Quebec poses unique challenges for trauma management. Our primary objective was to compare mortality rates between trauma patients treated at rural emergency departments (EDs) and urban trauma centres in Quebec. As a secondary objective, we compared the availability of trauma care resources and services between these two settings.

Design Retrospective cohort study.

Setting 26 rural EDs and 33 level 1 and 2 urban trauma centres in Quebec, Canada.

Participants 79 957 trauma cases collected from Quebec’s trauma registry.

Primary and secondary outcome measures Our primary outcome measure was mortality (prehospital, ED, in-hospital). Secondary outcome measures were the availability of trauma-related services and staff specialties at rural and urban facilities. Multivariable generalised linear mixed models were used to determine the relationship between the primary facility and mortality.

Results Overall, 7215 (9.0%) trauma patients were treated in a rural ED and 72 742 (91.0%) received treatment at an urban centre. Mortality rates were higher in rural EDs compared with urban trauma centres (13.3% vs 7.9%, p<0.001). After controlling for available potential confounders, the odds of prehospital or ED mortality were over three times greater for patients treated in a rural ED (OR 3.44, 95% CI 1.88 to 6.28). Trauma care setting (rural vs urban) was not associated with in-hospital mortality. Nearly all of the specialised services evaluated were more present at urban trauma centres.

Conclusions Trauma patients treated in rural EDs had a higher mortality rate and were more likely to die prehospital or in the ED compared with patients treated at an urban trauma centre. Our results were limited by a lack of accurate prehospital times in the trauma registry.

  • organisation of health services
  • trauma management

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  • Contributors RF, JPo, MO, J-PF, FLé, FLa and GD conceived the study, designed the protocol and obtained research funding. RF and CT-P performed the literature search. RF, FKT and ST supervised the data collection. RF, FLa, JPl, JM and ST provided statistical advice on study design and analysed the data. All authors contributed to interpreting the data and drafting the manuscript. All authors critically reviewed the manuscript for important intellectual content, approved the final version of the submitted manuscript and agree to be accountable for all aspects of the work.

  • Funding This work was supported by the Fonds de Recherche en Santé du Québec (FRSQ) - Consortium pour le développement de la recherche en traumatologie 2015–2018.

  • Competing interests None declared.

  • Ethics approval This study was approved by the CISSS Chaudière-Appalaches Research Ethics Committee (Project MP-2016-003).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data may be obtained from a third party and are not publicly available.

  • Patient consent for publication Not required.

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