Outcomes of trauma patients after transfer to a level I trauma center.
BACKGROUND
: Trauma center physicians need to know the patient's prognosis to make appropriate clinical decisions when they take over the care of a transferred patient. We sought to compare the survival of injured patients after transfer to a trauma center with survival from a comparable time after injury among patients who had been admitted to the trauma center directly from the scene of injury.


METHODS
: Study included 2,867 patients 18 years to 84 years of age with at least one Abbreviated Injury Scale score >/=3 injury transferred to a trauma center and 7,570 patients admitted directly to a trauma center. The outcome was death within one year after injury. Cox proportional hazards model for death was used accounting for time since injury, adjusted for age group, gender, injury severity, injury mechanism, and comorbidities.


RESULTS
: Overall, there was almost no increase in the adjusted risk of death for transfer patients in the year after injury [hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.78, 1.27]. The adjusted risk of death was higher in transfer patients than nontransfer patients between 50 days and 365 days after injury (HR 1.28, 95% CI 0.79, 2.07), but not within the first 50 days (HR 0.95, 95% CI 0.76, 1.18). However these modest differences in survival within each period were not statistically significant.


CONCLUSIONS
: After accounting for key demographic and clinical characteristics, transfer status does not appear to be a significant independent predictor of survival among patients with moderate to severe injuries treated at Level I trauma centers.
Rivara
Frederick P
FP
Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA. fpr@u.washington.edu
Koepsell
Thomas D
TD
Wang
Jin
J
Nathens
Avery
A
Jurkovich
Gregory A
GA
Mackenzie
Ellen J
EJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000592:standards; D005069:Evaluation Studies as Topic; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014187:Transportation of Patients / Q000592:standards* / Q000639:trends; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*