Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality.
BACKGROUND
Triage attempts to ensure that severely injured patients are transported to a high-level trauma facility to reduce mortality. However, some patients are triaged to the nearest medical facility before transport to a final destination trauma center (TC). We sought to analyze whether initial triage of critically injured patients to a nontrauma center (NTC) is associated with increased mortality.


METHODS
The Glue Grant Trauma Database of severely injured patients was analyzed. Mortality risk for patients who had an intermediate stop at another facility was compared with patients triaged directly from the scene to the TC. Patient demographics, time from injury to TC arrival, resuscitation volume, transfusions, head injury, initial systolic blood pressure, co-morbidities, and injury severity were included as confounders in a multivariate logistic regression model.


RESULTS
There were 1,112 patients of whom 318 (29%) were initially triaged to an NTC. After adjusting for confounders, this was associated with an increase in prehospital crystalloids (4.2 L vs. 1.4 L, p < 0.05) and a 12-fold increase in blood transfusions (60% vs. 5%, p < 0.001). Age, injury severity score, Acute Physiology and Chronic Health Evaluation II score, and time from injury to TC arrival were independent predictors of mortality. The odds of death were 3.8 times greater (95% CI, 1.6-9.0) when patients were initially triaged to a nontrauma facility.


CONCLUSIONS
Triaging severely injured patients to hospitals that are incapable of providing definitive care is associated with increased mortality. Attempts at initial stabilization at an NTC may be harmful. These findings are consistent with a need for continued expansion of regional trauma systems.
Nirula
Ram
R
Section of Burns/Trauma/Critical Care, Department of Surgery, University of Utah, Salt Lake City, Utah 84132, USA. r.nirula@hsc.utah.edu
Maier
Ronald
R
Moore
Ernest
E
Sperry
Jason
J
Gentilello
Larry
L
D000328:Adult; D000367:Age Factors; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012151:Resuscitation / Q000401:mortality; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000401:mortality*; D014949:Wounds, Nonpenetrating / Q000401:mortality