Direct transport versus inter hospital transfer of severely injured trauma patients |
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| Affiliation: | 1. Trauma Centre Brabant, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands;2. Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands;1. Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, United States;2. Bureau of Sciences Services, Wisconsin Department of Natural Resources, United States;3. National Farm Medicine Center, Marshfield Clinic Research Foundation, United States;1. Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA;2. Emergency Medical Services Agency, Los Angeles County Department of Health Services, Santa Fe Springs, CA, USA;1. Department of Surgery, University of Washington, Seattle, WA, USA;2. School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;3. Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana;4. Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq;5. Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq;6. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA;7. Department of Global Health, University of Washington, Seattle, WA, USA;8. Institute for Health Metrics and Evaluation, Seattle, WA, USA;9. Department of Health Services, University of Washington, Seattle, WA, USA;10. Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;11. Surgeons OverSeas (SOS), New York, NY, USA;12. Department of Surgery, Columbia University, New York, NY, USA;13. Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa;1. Department of Trauma Research, Medical Center of Plano, 3901 West 15th Street, Plano, TX 75075, United States;2. Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113, United States;3. Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228, United States;4. Trauma Services Department, Medical Center of Plano, 3901 W. 15th St, Plano, TX 75075, United States;5. Trauma Services Department, St. Anthony Hospital, 11600 West 2nd Place, Lakewood, CO 80228, United States;7. Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113, United States;6. Trauma Services Department, Intermountain Neurosurgery, 11700 W. 2nd Place, Lakewood, CO 80228, United States;8. Trauma Services Department, Rocky Vista University, 8401 S. Chambers Rd, Parker, CO 80134, United States;1. 14th Parachutist Forward Surgical Team, France;2. Department of Digestive Surgery, Val de Grace Military Teaching Hospital, 74 boulevard de Port Royal, 75005 Paris, France;3. Department of Orthopedic Surgery, Begin Military Teaching Hospital, 69 avenue de Paris, 94160 Saint Mandé, France;4. Medical Unit of the 8th French Military Parachutist Unit, avenue Jacques Desplats, 81100 Castres, France;5. Clinic of Traumatology and Orthopaedics, Percy Military Teaching Hospital, 101 avenue de Henri Barbusse, 92140 Clamart, France;6. French Military Health Service Academy, Ecole du Val de Grace, 1 place Alphonse Laveran, 75005 Paris, France;7. Intensive Care Unit, Begin Military Teaching Hospital, 69 avenue de Paris, 94160 Saint Mandé, France |
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| Abstract: | ![]()
IntroductionSeveral studies have suggested that severely injured patients should be transported directly to a trauma centre bypassing the nearest hospital. However, the evidence remains inconclusive. The purpose of this study was to examine the benefits in terms of mortality of direct transport to a trauma centre versus primary treatment in a level II or III centre followed by inter hospital transfer to a trauma centre for severely injured patients without Traumatic Brain Injury (TBI).Patients and methodsWe used the regional trauma registry and included all patients with an Injury Severity Score (ISS) >15 and an Abbreviated Injury Score <4 for head injury. We adjusted for survival bias by including “potential transfers”: patients who died at the nearest hospitals before transportation to a trauma centre.ResultsA total of 439 patients was included. The majority of patients (349/439, 79%) was transported directly to the level I trauma centre (direct group). The transferred group was formed by the remaining 90 patients, of whom 81 were transferred to the level I trauma centre after initial stabilisation elsewhere and 9 patients died in the emergency room before transfer to a level 1 trauma centre could occur. There were no significant differences in baseline and injury characteristics between the groups. Overall, 60 patients died in-hospital including 41 of the 349 patients (12%) in the direct group and 19 of the 90 patients (21%) in the transferred group. Nine of the 19 deaths in the transferred group were ascribed to potential transfers. After adjusting for prehospital Revised Trauma Score (RTS) and ISS, the odds ratio of death was 2.40 (95%CI: 1.07–5.40) for patients in the transfer group. When potential transfer patients were excluded from the analysis, the adjusted odds ratio of death was 1.14 (95%CI: 0.43–3.01).ConclusionsAfter adjusting for survivor bias by including potential transfers, the results of this study suggest a lower risk of death for patients who are directly transported to a level I trauma centre than for patients who receive primary treatment in a level II or III centre and are transferred to a trauma centre. However, this finding was only significant when adjusting for survival bias and therefore we conclude that it is still uncertain if there is a lower risk of death for patients who are transported directly to a level I trauma centre. |
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| Keywords: | Trauma centre Triage Mortality Trauma Severely injured patients Pre-hospital transport Pre-hospital care Trauma systems Multi trauma Inter hospital transfer |
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