A. Azim1, K. Prabhakaran1, M. Khan1, G. Lombardo1, J. Con1, R. Latifi1 1Westchester Medical Center,Surgery,Valhalla, NEW YORK, USA
Background:The management of low grade (I-III) solid organ (spleen, liver, kidney) injury has evolved to a predominantly conservative management approach with few of these patients requiring procedural intervention. Nonetheless, transfer of these patients from non-trauma centers or lower level trauma centers to Level I trauma centers is common. The objective of this study was to determine the difference in outcomes between patients transferred to and managed at a higher-level trauma center and those managed at a lower level trauma center (Level II/III).
Methods: A two-year retrospective analysis of the National Trauma Data Bank was performed. All trauma patients greater than 18 years of age with isolated low grade solid organ injury were identified. Patients were identified using ICD-10 codes and the following data points were obtained: age, gender race, admission vitals, transfer status, trauma center (TC) designation, and procedures performed. Patients were divided between 2 groups; those directly admitted to Lower Level TC or those transferred to higher Level TC Outcome measures were intervention (angioembolization or surgery) and mortality. A Chi square analysis was performed.
Results: A total of 917865 trauma patients with blunt mechanism of injury were analyzed of which 25, 619 patients had solid organ injury. A total of 1256 patients with isolated low grade solid organ injury were identified. Mean age was 43 ± 25 years, 75.2% were male, and 79.7% were white. Of these, 53.5% were transferred to Level-I trauma center and 46.4% were admitted to lower Level TC. Overall mortality rate was 1.4% and need for intervention was 4.7%. For low grade isolated splenic injuries, 47.7% were admitted to Low Level TC compared to 52.3% transferred to Level I TC. For low grade isolated liver injuries, 44.5% were admitted to Level II/III TC compared 55.5% to transferred to Level I TC. For low grade isolated kidney injuries, 41.2% were admitted to Low Level TC compared to 59.8% transferred to Level-1 TC. The overall rate of intervention at Lower level TC was 4.6% versus 4.8% for transferred patients (p=0.11) (Table 1.). Mortality rate was similar between the two groups (1.41% vs 1.38%) (p=0.08).
Conclusion:Few adult patients with low grade solid organ injury require intervention, even when transferred to a Level I Trauma Center. Patient with low grade solid organ injury can be safely managed at lower level trauma centers.
