Characteristics of twice-transferred, rural trauma patients.
OBJECTIVE
Undertriage has seldom been evaluated in the trauma population. In rural states patients often go to the nearest hospital first, where they are evaluated and, if necessary, transferred to another hospital. If they are undertriaged when transferred to the second hospital, they will require a second transfer to a higher-level trauma center.


METHODS
The authors retrospectively reviewed the charts of all trauma patients at a level I trauma center from 1996 to 1999 who were seen at two acute care facilities because of a single acute traumatic event before reaching the trauma center. Ninety-three patient charts were analyzed.


RESULTS
Forty-six percent of the patients were victims of a motor vehicle crash. Patients were mostly transferred to the level I trauma center for non-spine orthopedic injuries (28%), followed by spine injuries (14%) and head injuries (13%). These patients were stable, as manifested by an average trauma score of 11.6. However, there was a significant positive interaction between injury severity score and time to definitive care.


CONCLUSIONS
The authors infer from the data analysis that more serious or complex injuries took longer to evaluate. Since these patients were physiologically stable, reducing the number of twice-transferred trauma patients will involve refining transfer protocols concerning the need for specialty care.
Department of Surgery, University of Iowa, Iowa Ciy, USA.
Kristen C
KC
Sihler
Alfred R
AR
Hansen
James C
JC
Torner
G Patrick
GP
Kealey
Lori J
LJ
Morgan
Craig
C
Zwerling
D004632:Emergency Medical Services / Q000592:standards* / Q000639:trends; D005069:Evaluation Studies as Topic; D005260:Female; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D015601:Injury Severity Score; D007484:Iowa; D008297:Male; D008485:Medical Audit; D010360:Patient Transfer / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014193:Trauma Centers; D014218:Triage / Q000592:standards*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*