A multicenter evaluation on the impact of non-therapeutic transfer in rural trauma.

Document Type

Article

Publication Title

Injury

Abstract

INTRODUCTION: Trauma transfers are a common occurrence in rural areas, where critical access and lower-level trauma centers routinely transfer to tertiary care centers for specialized care. Transfers are non-therapeutic (NTT) when no specialist intervention occurs, leading to transfer that were futile (FT) or secondary overtriage (SOT). This study aimed to evaluate the prevalence of NTT among four trauma centers providing care to rural Appalachia.

METHODS: This retrospective review was performed at four, ACS verified, Level 1 trauma centers. All adult trauma patients, transferred during 2018 were included for analysis. Transfers were considered futile if inhospice, without operative intervention. SOT transfers were discharged inh, without major intervention, with an ISS< 15. Cost analysis was performed to describe the impact of NTT on EMS use.

RESULTS: 4,189 patients were analyzed during the study period. 105 (2.5%) met criteria for futility. Futile patients had a median ISS of 25 (IQR 9-26), and 48% had an AIS head ≥4. These were significantly greater (p

CONCLUSIONS: Non-therapeutic transfers account for more than 1/3 of transfers in this rural environment. There was a significant use of advanced life support and aeromedical transport. The utility of these transfers should be questioned. With the recent increases in telehealth there is an opportunity for trauma systems to improve regional care and decrease transfers for futile cases.

First Page

238

Last Page

242

DOI

10.1016/j.injury.2022.07.045

Publication Date

1-1-2023

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