J. Con1, D. M. Long1, G. Schaefer1, J. C. Knight1, K. J. Fawad1, A. Wilson1 1West Virginia University,Department Of Surgery / Division Of Trauma, Emergency Surgery And Surgical Critical Care,Morgantown, WV, USA
Introduction:
Rural hospitals have variable degrees of involvement within the nationwide trauma system because of differences in infrastructure, human resources and operational goals. “Secondary overtriage” is a term that has been used to describe the seemingly unnecessary transfers to another hospital, shortly after which the trauma patient is discharged home without requiring an operation. An analysis of these occurrences is useful to determine the efficiency of the trauma system as a whole. Few have addressed this phenomenom, and to our knowledge, we are the first to study it in the setting of a rural state's trauma system.
Methods:
Data was extracted from a statewide trauma registry from 2003-2013 to include those who were: 1) discharged home within 48h of arrival, and 2) did not undergo a surgical procedure. We then identified those who arrived as a transfer prior to being discharged (secondary overtriage) from those who arrived from the scene. Factors associated with transfers were analyzed using a logistic regression. Injuries were classified based on the need for a specific consultant. Time of arrival to ED was analyzed using 8-hour blocks, with 7AM-3PM as reference.
Results:
19,319 patients fit our inclusion criteria of which 1,897 (9.8%) arrived as transfers. The mean ISS was 3.8 ± 3 for non-transfers and 6.6 ± 5 for transfers (p<0.0001). Descriptive analysis showed various other differences between transfers and non-transfers due to our large sample size. Thus, we examined variables that had more clinical significance using logistic regression controlling for age, ISS, the type of injury, blood products given, the time of arrival to the initial ER, and whether a CT scan was obtained initially. Factors associated with being transferred were age>65, ISS>15, transfusion of PRBC’s, graveyard-shift arrivals, and neurosurgical, spine, and facial injuries. Orthopedic injuries were not associated with transfers. Patients having a CT scan done at the initial facility were less likely to be transferred.
Conclusion:
Although transferred patients were more severely injured, this was not the only factor driving the decision to transfer. Other factors were related to the rural hospital’s limited resources, which included the availability of surgical specialists, blood products, and overall coverage during the graveyard-shift. More liberal use of the CT scaner at the initial facility may prevent unnecessary transfers.
