Right Patient, Right Place, Right Time : Field Triage and Transfer to Level I Trauma Centers.
INTRODUCTION: This study sought to compare outcomes of trauma patients taken directly from the field to a Level I trauma center (direct) versus patients that were first brought to a Level III trauma center prior to being transferred to a Level I (transfer) within our inclusive Delaware trauma system.
METHODS: A retrospective review of the Level I center's trauma registry was performed using data from 2013 to 2017 for patients brought to a single Level I trauma center from 2 surrounding counties. The direct cohort consisted of 362 patients, while the transfer cohort contained 204 patients. Linear regression analysis was performed to investigate hospital length of stay (LOS), while logistic regression was used for mortality, complications, and craniotomy. Covariates included age, gender, county, and injury severity score (ISS). Propensity score weighting was also performed between the direct and transfer cohorts.
RESULTS: When adjusting for age, gender, ISS, and county, transferred patients demonstrated worse outcomes compared with direct patients in both the regression and propensity score analyses. Transferred patients were at increased risk of mortality (odds ratio [OR] 2.17, CI 1.10-4.37,
DISCUSSION: Delays in the presentation to our Level I trauma center resulted in worse outcomes. Patients that meet criteria should be considered for transport directly to the highest level trauma center in the system to avoid delays in care.
Published In/Presented At
Gough, B. L., Painter, M. D., Hoffman, A. L., Caplan, R. J., Peters, C. A., & Cipolle, M. D. (2020). Right Patient, Right Place, Right Time : Field Triage and Transfer to Level I Trauma Centers. The American surgeon, 86(12), 1697–1702. https://doi.org/10.1177/0003134820947385
Medicine and Health Sciences
Department of Surgery