{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:14:51Z","timestamp":1788347691630,"version":"build-2803163510"},"reference-count":10,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Rural residents are more likely to suffer moderate and severe traumatic brain injury (TBI) and experience delay to definitive care than urban patients. Prior studies comparing these populations were based on hospitalised patients only. We examined TBI outcomes incorporating pre\u2010hospital mortality to determine the association between location of injury and mortality risk.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Twelve\u2010month (2019) retrospective cohort study was performed on all adult patients with TBI within one Trauma System. Demographics, geographical location of injury, mechanism, scene vital parameters and interventions, injury severity, polytrauma status, TBI morphology and outcomes were collected for all hospital and prehospital deaths. Uni\u2010 and multivariate analysis was conducted including binary logistic regression to examine associations between mortality and potential confounders of mortality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 266 patients (145 hospitalised and 121 prehospital deaths) with median age 53.6\u2009years (18\u201398), 72.6% males, scene Glasgow Coma Scale (GCS) <\u200914 (48.3%), were included. Ninety\u2010four (36%) patients were urban and, 167 (64%) were regional, rural or remote. Rural compared to urban patients had higher risk of death (adjusted OR 1.934, 95% CI 1.07\u20133.49) without differences in GCS, pupillary status, injury pattern, radiological TBI severity or initial management. The strongest risk factor for mortality was polytrauma (adjusted OR 7.804, 95% CI 4.155\u201314.62,\n p<\/jats:italic>\n \u2009<\u20090.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Comprehensive assessment of TBI mortality indicates that rurality is associated with mortality and polytrauma status is a profound risk factor. These findings highlight that prehospital mortality is essential to monitor and optimisation of polytrauma care is a potential modifiable factor in TBI outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ans.70734","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T07:58:30Z","timestamp":1780646310000},"page":"2093-2101","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mortality From Rural Traumatic Brain Injury Are Underestimated Without Inclusion of Prehospital Deaths"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7858-9829","authenticated-orcid":false,"given":"Gareth","family":"Rutter","sequence":"first","affiliation":[{"name":"Department of Trauma John Hunter Hospital Newcastle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6656-5229","authenticated-orcid":false,"given":"Maria","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Trauma John Hunter Hospital Newcastle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Ferch","sequence":"additional","affiliation":[{"name":"Department of Trauma John Hunter Hospital Newcastle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1839-3490","authenticated-orcid":false,"given":"Mitchell A.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Trauma John Hunter Hospital Newcastle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt J.","family":"Balogh","sequence":"additional","affiliation":[{"name":"Department of Trauma John Hunter Hospital Newcastle Australia"},{"name":"School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753-6405.12878"},{"issue":"12","key":"e_1_2_9_3_1","first-page":"1","article-title":"Epidemiology and Outcomes of Brain Trauma in Rural and Urban Populations: A Systematic Review and Meta\u2010Analysis","volume":"38","author":"Chequer J.","year":"2024","journal-title":"Brain Injury"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-024-02573-0"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2012.01.011"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.1986.tb07099.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000186013.63046.6B"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2011.06.029"},{"key":"e_1_2_9_9_1","unstructured":"Australian Bureau of Statistics \u201cAustralian Statistical Geography Standard (ASGS) Edition 3 July 2021\u2013June 2026 Australian Bureau of Statistics \u201d2021 https:\/\/www.abs.gov.au\/statistics\/standards\/australian\u2010statistical\u2010geography\u2010standard\u2010asgs\u2010edition\u20103\/jul2021\u2010jun2026."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2022.05.001"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12974-016-0555-1"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70734","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.70734","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70734","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:33:10Z","timestamp":1788345190000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.70734"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":10,"journal-issue":{"issue":"7-8","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/ans.70734"],"URL":"https:\/\/doi.org\/10.1111\/ans.70734","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]},"assertion":[{"value":"2026-02-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}