A. N. Kulaylat1, M. Linskey1, S. B. Armen1, C. S. Hollenbeak1, R. E. Cilley1, B. W. Engbrecht1 1Penn State Hershey Medical Center,Department Of Surgery,Hershey, PA, USA
Introduction: Disparities in trauma care based on race and insurance status have been well-documented. This study was designed to evaluate if insurance status or race is associated with transfer of patients from Level 2 or 3 Trauma Centers to another Trauma Center using a state database.
Methods: The Pennsylvania Trauma Systems Foundation maintains a statewide database for all patients at accredited Trauma Centers that meet certain requirements. This is a retrospective review of that database for adult (≥ 18 yo) patients initially evaluated at Level 2 or Level 3 Adult Trauma Centers between July 1, 2008, and June 30, 2012. Multivariate analysis was used to assess for variables that might be associated with transfer to another Trauma Center, with p<0.05 considered significant.
Results:5% of Level 2 patients (n=37136) and 36% of Level 3 patients (n=2873) were transferred during the time studied. Factors associated with transfer included increasing ISS and Self-Pay status (OR 1.30 for Level 2, OR 1.36 for Level 3). Race had either no association or a negative association for transfer. Intracranial injury was associated with transfer from Level 3 Trauma Centers, but not Level 2 Trauma Centers. Age > 49 yo, female sex, and operation at the initial Trauma Center had negative associations with transfer. When stratified by race, insurance status maintained a significant association with transfer for White patients, but not for other Race/Ethnic groups.
Conclusion:The decision to transfer a patient from one Trauma Center to another Trauma Center is multifactorial. Insurance status, but not race, appears to be a factor in the decision to transfer a patient from Pennsylvania Level 2 and 3 Trauma Centers to another Trauma Center. The financial implications that this has on Level 1 Trauma Centers should be evaluated.
