Town-level comparisons may be an effective alternative in comparing rural and urban differences: A look at accidental traumatic brain injuries in North Texas children

Introduction: Rural areas in the USA are generally poorer, more isolated, less populated, have older populations, and also unique work dynamics that fundamentally set them apart from urban areas. Additionally, funding and resources are limited in rural areas; a problem that may be exacerbated when looking specifically at town-level resources. One of the key problems in comparing US rural and urban areas, particularly at the county level, is that the resources available to individual towns within a particular county may not accurately reflect the resources available to the county as a whole. This leads to questions about the validity of countylevel comparisons between rural and urban areas because of differences in town sizes and the resources availability at this level. The authors of this study attempted to assess this difference by analyzing data previously collected for a study examining pediatric traumatic brain injury among four levels of rurality: urban city, large town, small town, and isolated town. Methods: This study employed Rural and Urban Commuting Area 2 (RUCA2) codes to determine if significant differences exist between small and large towns for pediatric traumatic brain injury. Patients were included in this study if they presented to Children's Medical Center Dallas with severe traumatic brain injury, and comparisons of injury severity and outcome were compared between small and large towns. Patient zip (postal) codes were collected and designated as either small or large town based on the corresponding RUCA2 code. Results: A total of 444 patients were included in this study, with significant differences between large and small towns for Trauma Scores, Trauma Score and Injury Severity Score (TRISS) measures, and the total length of stay. Conclusion: This study has numerous limitations, yet it demonstrates that comparisons based on the RUCA code designations of large and small towns can be an effective means for understanding the differences at the town level, and also to better establish prevention strategies geared toward these differences.