T. J. Buchanan2, P. Pacurari2, G. Hobbs1, A. Wilson1, J. Con1 1West Virginia University,Department Of Surgery,Morgantown, WV, USA 2West Virginia University,School Of Medicine,Morgantown, WV, USA
Introduction: Rural hospitals triage and transfer the most severely injured patients; however, the rural practitioner will treat some patients with a relatively low injury severity. We intend to describe the population successfully treated at Level 3 and 4 Trauma Centers, and to identify factors associated with late transfers which could represent failed attempts at managing these patients. We hypothesize that certain pre-injury and injury characteristics are associated with these failed attempts.
Methods: The 2007-2014 West Virginia State Trauma registry was utilized to identify patients who were admitted to a Designated Level 3 or 4 Trauma Center for >48 hours. Two groups of patients were identified: those transferred to a higher level of care, and those discharged to a lower level of care, including home. Descriptive statistics of pre-injury and injury characteristics were obtained between transfer and non-transfer groups. A step-wise multivariate logistic regression model was used to predict which factors were associated with transfers.
Results: 21,046 patients fit the inclusion criteria, of which 1.54% were transferred, with a mean age of 70 years, and female predominance (64.97%). The majority of the population sustained a blunt injury, most frequently a fall, with a low Injury Severity Score (ISS) (Table 1). An ICU stay was required for 13% of the total population, 1.9% required mechanical ventilation, and 21.6% required a blood transfusion. Multiple factors were identified to be associated with transfers in the step-wise multivariate logistic regression: male gender (Odds Ratio=1.39, p<0.03), age ≥65 (OR=1.39, p<0.01), spine injury (OR=1.51, p<0.03), heart disease (OR=1.69, p<0.0002), diabetes (OR=1.48, p<0.002), functionally dependent health status (OR=0.56, p<0.03), and mechanical ventilation (OR=3.30, p<0.0001).
Conclusion: The trauma population hospitalized for >48h at West Virginia Level 3 and 4 Trauma Centers appear to be disproportionately older than the general population and have sustained relatively minor injuries from blunt mechanisms such as falls. A selection bias may be present due to a stay of >48h, but it does reflect the population hospitalized at these institutions at any given time. Factors associated with being transferred later in their care are not completely dependent on the characteristics of the injury; pre-injury conditions in the trauma patient play a significant role in these late transfers.
