Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome

Adrian T. Billeter; Frank B. Miller; Brian G. Harbrecht; Wanda Bowen; Matthew J. Stephens; Gregory C. Postel; Jason W. Smith; Matthew Penta; Royce Coleman; Glen A. Franklin; Donald D. Trunkey; Hiram C. Polk

doi:10.1016/j.amjsurg.2013.04.015

Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome

Adrian T. Billeter, Frank B. Miller, Brian G. Harbrecht, Wanda Bowen, Matthew J. Stephens, Gregory C. Postel, Jason W. Smith, Matthew Penta, Royce Coleman, Glen A. Franklin, Donald D. Trunkey, Hiram C. Polk

Trauma, Critical Care and Acute Care Surgery

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

Abstract

Background Stops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs). Methods We studied 754 consecutive blunt trauma patients with an Injury Severity Score greater than 20 with an emphasis on 212 patients who received care at other sites en route to our level 1 trauma center. Results Referred patients were older, more often women, and had more severe TBI (all P <.05). After correction for age, sex, and injury pattern, there was no difference in the type of TBI, Glasgow Coma Scale (GCS) upon arrival at the trauma center, or overall mortality between referred and directly admitted patients. GCS at the outside institution did not influence promptness of transfer. Conclusions Interhospital transfer does not affect the outcome of blunt trauma patients. However, the unnecessarily prolonged stay of low GCS patients in hospitals lacking neurosurgical care is inappropriate.

Original language	English (US)
Pages (from-to)	459-466
Number of pages	8
Journal	American journal of surgery
Volume	207
Issue number	4
DOIs	https://doi.org/10.1016/j.amjsurg.2013.04.015
State	Published - Apr 2014

Keywords

Head injuries
Imaging
Interhospital transfer
Referral
Trauma
Traumatic brain injury

ASJC Scopus subject areas

Surgery

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10.1016/j.amjsurg.2013.04.015

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Billeter, A. T., Miller, F. B., Harbrecht, B. G., Bowen, W., Stephens, M. J., Postel, G. C., Smith, J. W., Penta, M., Coleman, R., Franklin, G. A., Trunkey, D. D., & Polk, H. C. (2014). Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome. American journal of surgery, 207(4), 459-466. https://doi.org/10.1016/j.amjsurg.2013.04.015

Billeter, AT, Miller, FB, Harbrecht, BG, Bowen, W, Stephens, MJ, Postel, GC, Smith, JW, Penta, M, Coleman, R, Franklin, GA, Trunkey, DD & Polk, HC 2014, 'Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome', American journal of surgery, vol. 207, no. 4, pp. 459-466. https://doi.org/10.1016/j.amjsurg.2013.04.015

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title = "Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome",

abstract = "Background Stops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs). Methods We studied 754 consecutive blunt trauma patients with an Injury Severity Score greater than 20 with an emphasis on 212 patients who received care at other sites en route to our level 1 trauma center. Results Referred patients were older, more often women, and had more severe TBI (all P <.05). After correction for age, sex, and injury pattern, there was no difference in the type of TBI, Glasgow Coma Scale (GCS) upon arrival at the trauma center, or overall mortality between referred and directly admitted patients. GCS at the outside institution did not influence promptness of transfer. Conclusions Interhospital transfer does not affect the outcome of blunt trauma patients. However, the unnecessarily prolonged stay of low GCS patients in hospitals lacking neurosurgical care is inappropriate.",

keywords = "Head injuries, Imaging, Interhospital transfer, Referral, Trauma, Traumatic brain injury",

author = "Billeter, {Adrian T.} and Miller, {Frank B.} and Harbrecht, {Brian G.} and Wanda Bowen and Stephens, {Matthew J.} and Postel, {Gregory C.} and Smith, {Jason W.} and Matthew Penta and Royce Coleman and Franklin, {Glen A.} and Trunkey, {Donald D.} and Polk, {Hiram C.}",

note = "Funding Information: Supported in part by the Price Trust Fund and by the Joint Royal College of Surgeons of Edinburgh/James and Emmeline Ferguson Research Fellowship Trust. ",

year = "2014",

month = apr,

doi = "10.1016/j.amjsurg.2013.04.015",

language = "English (US)",

volume = "207",

pages = "459--466",

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T1 - Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome

AU - Billeter, Adrian T.

AU - Miller, Frank B.

AU - Harbrecht, Brian G.

AU - Bowen, Wanda

AU - Stephens, Matthew J.

AU - Postel, Gregory C.

AU - Smith, Jason W.

AU - Penta, Matthew

AU - Coleman, Royce

AU - Franklin, Glen A.

AU - Trunkey, Donald D.

AU - Polk, Hiram C.

N1 - Funding Information: Supported in part by the Price Trust Fund and by the Joint Royal College of Surgeons of Edinburgh/James and Emmeline Ferguson Research Fellowship Trust.

PY - 2014/4

Y1 - 2014/4

N2 - Background Stops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs). Methods We studied 754 consecutive blunt trauma patients with an Injury Severity Score greater than 20 with an emphasis on 212 patients who received care at other sites en route to our level 1 trauma center. Results Referred patients were older, more often women, and had more severe TBI (all P <.05). After correction for age, sex, and injury pattern, there was no difference in the type of TBI, Glasgow Coma Scale (GCS) upon arrival at the trauma center, or overall mortality between referred and directly admitted patients. GCS at the outside institution did not influence promptness of transfer. Conclusions Interhospital transfer does not affect the outcome of blunt trauma patients. However, the unnecessarily prolonged stay of low GCS patients in hospitals lacking neurosurgical care is inappropriate.

AB - Background Stops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs). Methods We studied 754 consecutive blunt trauma patients with an Injury Severity Score greater than 20 with an emphasis on 212 patients who received care at other sites en route to our level 1 trauma center. Results Referred patients were older, more often women, and had more severe TBI (all P <.05). After correction for age, sex, and injury pattern, there was no difference in the type of TBI, Glasgow Coma Scale (GCS) upon arrival at the trauma center, or overall mortality between referred and directly admitted patients. GCS at the outside institution did not influence promptness of transfer. Conclusions Interhospital transfer does not affect the outcome of blunt trauma patients. However, the unnecessarily prolonged stay of low GCS patients in hospitals lacking neurosurgical care is inappropriate.

KW - Head injuries

KW - Imaging

KW - Interhospital transfer

KW - Referral

KW - Trauma

KW - Traumatic brain injury

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Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome

Abstract

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