Use of the "crash room" in a rural hospital: case review of 100 cases.

Introduction: There is little published literature about the characteristics of patients with high triage levels seen in the emergency departments of rural hospitals. We sought to determine the demographics of patients brought into the "crash room" of a rural hospital, to assess the pathologies that brought them to the hospital and to study their final disposition.

Methods: We conducted a retrospective chart review of visits to the crash room of our rural hospital. We used the hospital's crash room register to compile a list of the last 100 consecutive visits to the crash room as of July 20, 2011. We extracted initial data from the register and additional data by chart review.

Results: Patients with triage levels 1 to 3 were brought to the crash room at a rate of 0.36 cases/wk/1000 population. Although circulatory disease, respiratory disease and "chest pain" accounted for 44.6% of final diagnoses, a wide range of pathology was seen in the crash room. Trauma and poisonings, and mental disorders accounted for 21.0% and 9.0% of diagnoses, respectively. The final diagnosis was nonspecific, vague or "unknown" in 20% of the visits. Of the crash room cases, 17% required transfer to a secondary care hospital.

Conclusion: Crash room visits in this rural hospital occurred at a rate of 0.48 cases/wk/1000 population. Most patients seen in the crash room were not given the traditional triage levels 1 or 2 that are usually associated with crash room care. The final diagnosis was nonspecific in 17.0% of cases, and mental disorders accounted for 9.0% of crash room visits.