Most Patients with Severe Trauma Are Not Transferred to Trauma Centers

Ali S. Raja, MD, MBA, MPH, FACEP

While insurance status may have played a role in the decision to not transfer patients, hospital capabilities and injury patterns were likely more influential.

Critically ill trauma patients have better outcomes when treated at designated trauma centers, yet many such patients are not transferred (NEJM Journal Watch Emerg Med Jun 26 2009 and NEJM Journal Watch Emerg Med Jan 7 2011). Researchers analyzed the 2009 Nationwide Emergency Department Sample to identify factors associated with admission versus transfer to a trauma center.

Of 4513 adults under age 65 with major trauma (Injury Severity Score >15) initially treated at nontrauma hospitals, only 45% were transferred to trauma centers. Admission rather than transfer was more likely if the initial hospital was a metropolitan teaching hospital (26% higher adjusted absolute risk of admission), the patient had severe abdominal injuries (16% higher risk), or the patient had Medicaid, Medicare, private, or other insurance (14%, 13%, 11%, and 13% higher risk, respectively). Conversely, transfer was more likely if the initial hospital was a rural hospital (20% lower risk of admission) or the patient had severe head and neck injuries (13% lower risk).

Citation(s):

Delgado MK et al. Factors associated with the disposition of severely injured patients initially seen at non-trauma center emergency departments: Disparities by insurance status. JAMA Surg 2014 Feb 19; [e-pub ahead of print].