Characteristics of Trauma Transfer Patients from Community Affiliates of a Level One Trauma Center
Meagan Derbyshire, Kristina Kramer, Eleanor Winston, Edward Kelly, Tovy Kamine
Surgery, Baystate Medical Center, Springfield, Massachusetts, United States
Objective. Determine the number and characteristics of trauma patients transferred from community affiliates. Determine the level of care, required procedures and which transfers could potentially be kept at the community hospital with appropriate trauma surgery consultation. Design. Retrospective cohort study. Setting. Tertiary care center (level one trauma center) and affiliated community hospitals. Patients. Adult patients (aged 16 or older) with traumatic diagnoses transferred from community affiliates in 2019, of any race or ethnicity (n=179). Interventions. Transfer for trauma evaluation. Main Outcome Measures. Admission to higher level of care (step down/ICU) or required IR/OR procedure. Results. 41%(73/179) of patients required higher level of care or procedural intervention, and therefore considered a "necessary transfer," while 59%(106/179) required neither and were considered potentially able to be kept at the community affiliate. There was no statistical difference in gender or age between the two groups. In the "necessary transfer" group, the Injury Severity Score(!SS) was higher (12.5 v 8.8, p<0.01), length of stay(LOS) longer (7.0 v 4.2days, p<0.01), and the mortality rate higher (9.6% v 0.9%, p<0.01). While not statistically significant, the "necessary transfer" demonstrated an increased rate of unplanned ICU admissions (5.5% v 0.9%, p=0.07). Conclusions. Our criteria for "necessary transfer" appear internally valid based on the significant ISS, LOS and mortality rate difference. 449 patient-days at the Level One trauma center could be potentially avoided with appropriate trauma surgical consultation at the community affiliates. These unneeded transfers can translate to cost savings and increased bed availability at the Level One trauma center. Level One trauma centers should investigate ways to provide appropriate trauma care at community affiliates.
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