Financial triage in transfer of trauma patients: a myth or a reality?
BACKGROUND
It has been alleged that smaller hospitals transfer out uninsured trauma patients (wallet biopsy), putting the financial burden on major trauma centers.


METHODS
We undertook a retrospective analysis of the National Trauma Data Bank to compare patients who received care at major trauma centers after being transferred from another hospital (transfer group, n = 72,900) with patients who received definitive care at a smaller hospital (nontransfer group, n = 6,826).


RESULTS
Transfer patients were more likely to be uninsured (18% vs 14%; P < .001), but were more severely injured (Injury Severity Score, 11 +/- 10 vs 7 +/- 7; P < .001), or had multiple injuries. After adjustment for these differences, uninsured patients were no more likely to be transferred than insured ones (odds ratio, .95; 95% confidence interval, .88-1.04; P = .3).


CONCLUSIONS
There was no relationship between lack of insurance and likelihood of transfer to a major trauma center.
Department of Surgery, Division of Burns, Trauma and Surgical Critical Care, University of Texas Southwestern Medical School, Dallas, TX 75390-9158, USA.
Jennifer
J
Parks
Larry M
LM
Gentilello
Shahid
S
Shafi
D005260:Female; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage; D008297:Male; D017057:Medically Uninsured; D009104:Multiple Trauma; D010360:Patient Transfer; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014218:Triage