W. Rehrer1, I. Puente1,2,3,4, J. Wycech Knight1,2, A.A. Fokin2,3 1Broward Health Medical Center, Trauma Services, Fort Lauderdale, FL, USA 2Delray Medical Center, Trauma Services, Delray Beach, FL, USA 3Florida Atlantic University, Charles E Schmidt College Of Medicine, Boca Raton, FL, USA 4Florida International University, Herbert Wertheim College Of Medicine, Miami, FL, USA
Introduction: Transfers constitute a significant share of admissions to a trauma center (TC). The aim was to compare injury characteristics, outcomes and rates of overtriage in patients with different modes of arrival at non-trauma centers (NTC) who were then transferred to a tertiary TC.
Methods: This IRB approved retrospective cohort study included 1,948 patients transferred from NTC to an urban level 1 TC over a 3.5 year period. Two groups were compared: 661 patients initially transported from the scene of injury to NTC by private transportation and 1,287 patients initially transported by emergency medical services (EMS). All patients were transferred from NTC to TC by EMS. Analyzed variables included: age, sex, comorbidities, mechanism of injury (MOI), injury severity score (ISS), Glasgow coma scale (GCS), transfer reason and timing, surgery rates, intensive care unit (ICU) admissions, hospital length of stay (HLOS), mortality, insurance status and secondary overtriage (SOT). SOT was defined as TC discharge within 48 hours from admission without surgical intervention, ICU admission or death.
Results: TC transfers with initial private transportation to NTC compared to initial EMS transportation were significantly younger (61 vs 70 years old, p<0.001), had less comorbidities (74% vs 85%, p<0.001) and were less severely injured (ISS: 11 vs 12, p=0.03; GCS: 15 vs 14, p<0.001). Falls were the main MOI in both groups (70% vs 72%), however motor vehicle collisions were less common in the private group (14% vs 21%). Main reason for transfer in both groups was a head injury (56% vs 59%), followed by a spine injury (17% vs 21%). The average time from NTC admission to TC admission was similar (4.1 vs 4.3 hours) and was equal between NTC arrival – TC consultation and TC consultation – TC admission. Surgery rates were similar (17% vs 19%). [Figure] Private group required less ICU admissions (40% vs 49%, p<0.001) and had a shorter HLOS (4 vs 5 days, p=0.001). Mortality was 3 times lower in the private group (3% vs 9%, p<0.001). SOT in the private group was significantly higher (39% vs 26%, p<0.001). Distribution of insurance coverage was different (p<0.001), with the private group having more uninsured patients (27% vs 19%) and less Medicare insurance (45% vs 61%). Multivariable analysis revealed that significant independent predictors of SOT are higher GCS, lower ISS, orthopedic injuries and abdominal injuries (all p<0.05).
Conclusion: Patients privately transported from the scene of injury to NTC and later transferred to TC are less injured and have a higher secondary overtriage rates that patients initially transported by EMS.