What Happens When a Town’s Only Hospital Shuts Down?

From US News & World Report:

A combination of health care economics, political forces and demographic trends have triggered a quiet epidemic of hospital closures throughout the country. The problem stretches from rural areas like Center, Tex., where young Edith died in August, to hard-hit urban communities in cities like Detroit, Los Angeles and Washington, D.C.

According to the federal Office of Rural Health Policy, researchers at the University of North Carolina have determined that there are 640 counties across the country without quick access to an acute-care hospital — roughly 20 percent of the nation’s 29,000 residential areas.

Emergency Access to Neurosurgical Care for Patients with Traumatic Brain Injury

From the Journal of the American College of Surgeons:


Traumatic brain injury (TBI) is one of the most common causes of injury-related morbidity and mortality. Access to neurosurgical services is critical to optimal outcomes through reduction of secondary injury. We sought to evaluate variations in access to neurosurgical care across a regional trauma system.

Study Design

This is a population-based retrospective cohort study of patients who sustained isolated severe TBI from 2005-2009. Administrative datasets capturing all ED visits and hospitalizations were linked deterministically. Differences between access to a trauma center (TC) defined as direct transport from scene or transfer from a non trauma center (NTC) as opposed to no access were evaluated; this included patient level determinants of access to TC and delineation of mortality differences between TC and NTC care. Transfer patterns from NTC to TC were also evaluated.


We identified 9,448 patients with isolated severe TBI. Almost two thirds (60%, n=5701) received initial care at a NTC. Of these patients, 30% (n=1737) were subsequently transferred to a TC. 30-day mortality of patients treated at TC vs. NTC was 19% vs. 18% respectively (p=0.19). 67% of patients < 65 received TC care while only 41% of patients > 65 were treated at a TC (P<.01). Mechanism, age, brain hemorrhage and injury severity were associated with TC care.


Considerable variation in delivery of initial care to TBI patients was identified. Factors such as age and injury characteristics were associated with TC access. Because early TC care in TBI confers survival benefits, the demonstrated variability necessitates improvements in access to care for patients with severe head injuries.

Barriers to optimal access to neurosurgical care for patients with traumatic brain injury exist. Impediments include patient and injury characteristics. Factors impeding access remain similar both for transfer from scene to neurosurgical hospital and for transfer from non-neurosurgical hospital to neurosurgical hospital.