Nationwide secondary overtriage in level 3 and level 4 trauma centers: are these transfers necessary?

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• 作者：Kevin T. Lynch ; BS^a ; Rachael M. Essig ; BS^a ; Dustin M. Long ; PhD^b ; Alison Wilson ; MD^c ; Jorge Con ; MD^c ; ^{jocon@hsc.wvu.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Secondary overtriage ; CT scan ; Triage ; Trauma system ; Transfers ; Rural
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：204
• 期：2
• 页码：460-466
• 全文大小：464 K

文摘

Secondary overtriage (SO) refers to the interfacility transfer of trauma patients who are rapidly discharged home without surgical intervention by the receiving institution. SO imposes a financial hardship on patients and strains trauma center resources. Most studies on SO have been conducted from the perspective of the receiving hospital, which is usually a level 1 trauma center. Having previously studied SO from the referring rural hospital's perspective, we sought to identify variables contributing to SO at the national level.

Methods

Using data from the 2008-2012 National Trauma Data Bank, we isolated patients transferred to level 1 trauma centers who were: (1) discharged home within 48 h and (2) did not undergo any surgical procedure. This population was subsequently compared with similar patients treated at and discharged directly from level 3 and 4 centers. Multivariate logistic regression analysis was used to isolate variables that independently influenced a patient's risk of undergoing SO. Injury patterns were characterized by use of subspecialty consultants.

Results

A total of 99,114 patients met inclusion criteria, of which 13.2% were discharged directly from level 3 or 4 trauma centers, and 86.8% of them were transferred to a level 1 trauma center before discharge. The mean Injury Severity Score of the nontransfer and transfer groups was 5.4 ± 4.5 and 7.3 ± 5.7, respectively. Multivariate regression analysis showed that Injury Severity Score > 15, alcoholism, smoking, drug use, and certain injury patterns involving the head, vertebra, and face were associated with being transferred. In this minimally injured population, factors protective against transfers were: age > 65 y, female gender, systolic blood pressure <80, a head computed tomography scan and orthopedic injuries.

Conclusions

SO results from the complex interplay of variables including patient demographics, facility characteristics, and injury type. The inability to exclude a potentially devastating neurologic injury seems to drive SO.