Trauma Outcomes Based on Remoteness of Injury in Australia: A Systemic Review.

Introduction: Research suggests a significant disparity between rural and urban trauma patient outcomes, causing substantial social, economic and emotional costs, impacting health-related quality of life and functionality, and straining our healthcare system. There has not been a systematic examination of contributing factors in Australia.

Objective: This study aims to systematically describe the nature of research on trauma outcomes by geographical location and (where possible) describe factors found to increase or decrease the likelihood and severity of injury in rural Australia.

Design: Five databases (EMBASE, PubMed/MEDLINE, Web of Science, Scopus, CINAHL) and reference lists were searched. Eligible studies compared injury outcomes by geographic location in Australia, using a quantitative study design. No restrictions were placed on publication year or outcomes explored. The results were synthesised narratively.

Findings: We found 14 papers. Mortality, the most studied outcome (n = 11), was overall positively related to traumatic incidents in more rural locations. Other data outcomes included hospital admissions and length of stay, admission to ICU, 28-day hospital readmission, rehabilitation, and patient-reported quality of life. Study findings show different mechanisms of injury (e.g., falls) and limited accounts of pre-hospital experiences.

Discussion: Geographical location of trauma may impact the likelihood of injury mortality but is potentially confounded by the different mechanisms and severity of injury. There is insufficient evidence to make conclusions on other non-mortality and longer-term outcomes, and a greater understanding of prehospital outcomes is also needed.

Conclusion: This relationship is considered weak due to the limited geographic representation across Australia and the general paucity of recent literature.