TOPLINE: 

Patients with trauma in rural areas of Montana and neighboring regions experienced marked delays in definitive care, averaging 7-h transfers over 188 miles, far exceeding the "golden hour", a study found. Patients with more severe injuries had an increased risk for mortality, irrespective of transfer status.

METHODOLOGY:

• A retrospective, single‑center study examined 4213 trauma activations at a rural level I trauma center in the Northwestern US from 2012 to 2022.
• Patients included those admitted directly from the scene to tertiary centers (n = 2221; mean age, 44.8 years) and those transferred from other facilities to tertiary centers (n = 1992; mean age, 48.1 years).
• Data on patient demographics, Injury Severity Score (ISS), shock index, vital signs, and comorbidities were collected.
• Outcomes were mortality rates and length of hospital stay. Exploratory outcomes were prehospital and transfer times, transfer distances, hospital and ICU length of stay, and independent predictors of mortality.

TAKEAWAY:

• Patients transferred from other facilities had higher unadjusted mortality rates (5.0% vs 3.0%; P < .0001), higher mean ISSs (14.5 vs 8.3; P < .0001), longer hospital stays (6.0 vs 3.0 days; P < .0001), and longer ICU stays (4.6 vs 3.7 days; P = .0045) than those admitted directly from the scene. Patients transferred from other facilities also reached the tertiary center much later (mean, 7:01 vs 2:04 hours; P < .0001) and traveled greater distances (mean, 188.4 vs 18.1 miles; P < .0001) than those admitted directly from the scene.
• Transfer status was not an independent predictor of survival (odds ratio [OR], 0.97; P = .89). Patients with an ISS < 15 had higher odds of survival than those with an ISS ≥ 15 (OR, 3.13; P = .001).
• Most transfers (81.4%) originated from small or isolated rural towns with limited surgical coverage. Isolated rural facilities were far less likely than urban facilities to have on-call surgeons (12.6% vs 93.2%; P < .001) and relied more heavily on advanced practice providers (P < .001).
• Odds of survival decreased by 5% for every additional year of age (OR, 0.95 per year; P < .001) and for each 1-point increase in ISS (OR, 0.91; P < .001). Patients' survival was positively associated with longer hospital length of stay (OR, 1.12 per day; P < .001), whereas it was negatively associated with a higher shock index (OR, 0.53; P = .004).

IN PRACTICE:

"Rural trauma patients experience significant delays in access to definitive care. Enhancing resources and trauma training for rural providers, particularly advanced practice providers, may mitigate outcome dispar­ities across geographically underserved regions. Further regional studies are needed to reduce time to definitive care," the authors wrote.

SOURCE:

The study was led by Jung G. Min, MD, Stanford University, Stanford, California. It was published online on February 2, 2026, in The American Journal of Emergency Medicine.

LIMITATIONS: 

The study was limited by missing data on injury time in half of the population, which significantly affected the researchers' ability to assess the impact of transport time on outcomes and may have led to errors. The single-center design and the inability to include patients who died before transfer further limited the generalizability of the findings. 

DISCLOSURES:

The study did not receive any funding. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.