• GoldsteinAdam LeeAL0000-0002-9591-2939Trauma Surgery Unit, Wolfson Medical Center, Ha-Lokhamim St 62, Holon, 5822012, Israel. adamg.barefoot@gmail.com., Yarden Machlouf, Daniella Moshe, Shachar Laks, Abu AkarFirasFThoracic Surgery Unit, Wolfson Medical Center, Holon, Israel., Ronit Bar-Haim, Barak Levit, Alaa Awad, Adva Rom, and Ory Wiesel.
• Trauma Surgery Unit, Wolfson Medical Center, Ha-Lokhamim St 62, Holon, 5822012, Israel. adamg.barefoot@gmail.com.
• Eur J Trauma Emerg Surg. 2025 Jan 24; 51 (1): 5656.

PurposeEqual level trauma centers in the same country might have significant differences regarding their demographics and types of trauma. Understanding geographic variations in injury patterns are essential for optimal care. Here we describe the differences in injury patterns and associated outcomes of thoracic trauma patients between rural and urban level-II trauma centers in a single country.MethodA retrospective analysis of patients with thoracic trauma over a three-year period in a rural level-II and an urban level-II in Israel were compared. Demographics, mechanism of injury, prehospital care, transport, hospitalization course, discharge disposition, and outcomes were all analyzed.ResultsThere were significant differences between the demography, mechanisms of injury, and sustained injuries. The urban population was older, with more pedestrians hit by motor vehicles, falls from standing or sitting, and penetrating injuries. The rural population suffered from more motor vehicle crashes and falls from heights, with injuries related to higher velocity mechanisms such as lung contusions, sternal fractures, and liver injuries. There was no significant difference in transportation time or injury severity scores. More advanced life support ambulances were utilized in the rural setting together with more transfers to a higher level of care, while more patients in the urban center were lost to follow-up.ConclusionUnderstanding the differences between geographic locations is crucial towards optimizing trauma care. The complexities of thoracic trauma patients are an important example of the variations between rural and urban trauma centers. Respecting these differences will help to improve preparedness and treatment for trauma patients.© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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