Rural hospital transfer patterns before and after implementation of a statewide trauma system

N. Clay Mann, Jerris R. Hedges, Richard Mullins, Mark Helfand, William Worrall, Andrew D. Zechnich, Donald Trunkey, Patricia Southard, Melanie Zimmer-Gembeck, Donna Rowland, Alice Rogers

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Objective: To evaluate trauma transfer practices in rural Oregon before and after implementation of a state-wide trauma system. Methods: A pre- vs post-system implementation (historical control) analysis of trauma transfer practices was performed using a sample of rural ED trauma patients from 4 Level-3 and 5 Level-4 trauma hospitals. Medical records of patients with specific index injury diagnoses in 4 anatomic regions (head, chest, liver/spleen, and femur/open-tibia) were reviewed for a 3-year period before statewide trauma system implementation and 3 years after hospital trauma designation. Results: Of 1,057 patients entered into the database, 532 were evaluated during the pre-system period and 525 were evaluated during the post-system period. Overall, 47% had head injuries, 34% had chest injuries, 23% had femur/open-tibia injuries, and 12% had spleen/liver injuries. There were 142 (13%) patients with an injury in >1 index area. After trauma system implementation, there was a significant increase in the proportion of ED trauma patients transferred from Level-4 trauma hospitals (32% vs 68%, p < 0.001), with a corresponding decrease in the number of hospital admissions to these facilities (63% to 29%, p < 0.001). Significant increases in the proportion transferred from Level-4 trauma hospital EDs were noted for all index injury categories (p < 0.001). Trauma patients presenting to Level-4 EDs were significantly more likely to be transferred to Level-2 facilities (66% vs 82%, p = 0.030), while patients at Level-3 facilities were significantly more likely to be transferred to Level-1 centers (2% vs 14%, p = 0.002) following trauma system implementation. Multiple logistic regression modeling indicated that implementation of the statewide trauma system was an independent predictor of rural trauma patient transfer from Level-4 hospitals, while transfers from Level-3 facilities were dependent on type of injury. Conclusion: Implementation of the Oregon statewide trauma system was associated with a redistribution of rural trauma patients tO trauma hospitals with greater therapeutic resources.

Original languageEnglish (US)
Pages (from-to)764-771
Number of pages8
JournalAcademic Emergency Medicine
Issue number8
StatePublished - 1997


  • Outcomes
  • Patient transfer
  • Rural trauma
  • Trauma system

ASJC Scopus subject areas

  • Emergency Medicine


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