Date of Award

Spring 4-10-2026

Embargo Period

4-20-2026

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

Additional College

College of Health Professions

Abstract

Purpose:  To examine 48-hour in-hospital mortality among trauma admissions and evaluate patient- and hospital-level factors associated with early death, with emphasis on rural–urban differences.

Methods:  This retrospective observational study used the 2022 Healthcare Cost and Utilization Project–National Inpatient Sample (HCUP-NIS). Trauma admissions were identified using HCUP injury indicators and ICD-10-CM codes restricted to initial encounters. To reduce transfer-related bias, analyses were limited to non-transfer admissions after excluding 22,195 transfer-in cases, 6,723 transfer-out cases, and 66 observations with missing data, yielding 182,560 admissions. Early mortality was defined as death within 48 hours. Bivariate differences were assessed using χ² tests, and multivariable logistic regression estimated adjusted associations.

Findings: Overall, 1.22% of patients died within 48 hours of admission. Early mortality varied across patient- and hospital-level characteristics (p < .001), although absolute differences were modest. Notably, mortality was higher among admissions to urban versus rural hospitals (1.4% vs 0.8%), among patients with multiple injuries compared to those with a single injury (1.6% vs 0.7%), and among males (1.6% vs 0.8%) in females.  After adjusting for both hospital and patient-level covariates in a logistic regression, admission to a rural hospital for trauma was associated with significantly lower odds of 48-hour mortality (OR= 0.70).

Conclusions: Early mortality within 48 hours of trauma admission is uncommon but clinically meaningful, occurring during a highly time-sensitive phase of care characterized by intensive resource utilization. In this analysis, rural hospital status emerged as a key determinant of early survival, with patients treated in rural hospitals demonstrating lower adjusted odds of 48-hour mortality compared with those treated in urban hospitals. While injury complexity and patient characteristics remain important contributors to risk, these factors function primarily as covariates within the model. These findings highlight the need to interpret early trauma outcomes within the context of rural access, transfer dependence, and system-level care pathways, with important implications for trauma system performance, interfacility coordination, and policy efforts aimed at strengthening rural hospital readiness.

Rights

Copyright is held by the author. All rights reserved.

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