Citation

Adzemovic T, Murray T, Jenkins P, Ottosen J, Iyegha U, Raghavendran K, Napolitano LM, Hemmila MR, Gipson J, Park P, Tignanelli CJ. J. Trauma Acute Care Surg. 2019; ePub(ePub): ePub.

Affiliation

Department of Surgery, University of Minnesota, Minneapolis, MN Institute for Health Informatics, University of Minnesota, Minneapolis, MN.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002248

PMID

30830053

Abstract

INTRODUCTION: Interfacility transfer of patients from level III/IV to level I/II (tertiary) trauma centers has been associated with improved outcomes. However, little data are available classifying the specific subsets of patients that derive maximal benefit from transfer to a tertiary trauma center. Drawbacks to transfer include increased secondary overtriage. Here, we ask which injury patterns are associated with improved survival following interfacility transfer.

METHODS: Data from the National Trauma Data Bank was utilized. Inclusion criteria were adults (≥16 years). Patients with Injury Severity Score (ISS) < 10 or those who arrived with no signs of life were excluded. Patients were divided into two cohorts: those admitted to a level III/IV trauma center versus those transferred into a tertiary trauma center. Multiple imputation was done for missing values and propensity scores were generated based on demographics, injury patterns, and disease severity. Using propensity score stratified Cox proportional hazards regression, the hazard ratio for time to death was estimated.

RESULTS: 12,534 (5.2%), were admitted to level III/IV trauma centers and 227,315 (94.8%) were transferred to a tertiary trauma center. Patients transferred to a tertiary trauma center had reduced mortality (HR 0.69, p<0.001). We identified that patients with TBI with GCS < 13, pelvic fracture, penetrating mechanism, solid organ injury, great vessel injury, respiratory distress, and tachycardia benefited from interfacility transfer to a tertiary trauma center. 56.8% of patients in this sample benefitted from transfer. Among those not transferred, 49.5% would have benefited from being transferred.

CONCLUSION: Interfacility transfer is associated with a survival benefit for specific patients. These data support implementation of minimum evidence-based criteria for interfacility transfer. LEVEL OF EVIDENCE: Diagnostic Tests or Criteria, Level III.

Language: en