title: Rural hospital transfer patterns before and after implementation of a statewide trauma system. OHSU Rural Trauma Research Group.
abstract: OBJECTIVE
  To evaluate trauma transfer practices in rural Oregon before and after implementation of a statewide 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.
  
  
  CONCLUSIONS
  Implementation of the Oregon statewide trauma system was associated with a redistribution of rural trauma patients to trauma hospitals with greater therapeutic resources.
authors.affiliation: Oregon Health Sciences University, School of Medicine, Portland 97201, USA. manncl@ohsu.edu
authors.forename: N C
authors.initials: NC
authors.lastname: Mann
authors.forename: J R
authors.initials: JR
authors.lastname: Hedges
authors.forename: R J
authors.initials: RJ
authors.lastname: Mullins
authors.forename: M
authors.initials: M
authors.lastname: Helfand
authors.forename: W
authors.initials: W
authors.lastname: Worrall
authors.forename: A D
authors.initials: AD
authors.lastname: Zechnich
mesh_terms: D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006284:Health Plan Implementation; D006780:Hospitals, Rural; D006801:Humans; D016015:Logistic Models; D008297:Male; D009922:Oregon; D010360:Patient Transfer; D012189:Retrospective Studies; D014218:Triage