title: Is trauma transfer influenced by factors other than medical need? An examination of insurance status and transfer in patients with mild head injury.
abstract: BACKGROUND
  The Emergency Medical Treatment and Active Labor Act was meant to provide access to emergency medical care irrespective of financial resources. Yet, many Level I trauma Centers have raised concerns about the financial drivers influencing transfer.
  
  
  OBJECTIVE
  : To study the relationship between insurance status and transfer, we focused on patients with mild head injury to tease apart the medical necessity for transfer from other potential drivers, such as financial factors.
  
  
  METHODS
  Using the 2002 to 2006 American College of Surgeons National Trauma Databank and Massachusetts General Hospital's Trauma Databank from 1993 to 2009, we conducted a retrospective study and limited our population to patients with mild head injuries and mild to moderate systemic injuries as determined by the Glasgow Coma Scale, Abbreviated Injury Scale, or Injury Severity Score. Statistical analyses were conducted with STATA software.
  
  
  RESULTS
  In a nationalized database, (1) uninsured patients with mild head injury are more likely to be transferred out of a Level II or III facility (adjusted odds ratio [OR]: 2.07; P = .000) compared with privately insured patients and (2) uninsured patients are less likely to be accepted by a Level II or III facility for transfer compared with privately insured patients (adjusted OR: = .143; P = .000l). For transfers received by 1 Level I trauma center (Massachusetts General Hospital), uninsured patients are more likely to be transferred to (1) Massachusetts General Hospital between midnight and 6 am (adjusted OR: 5.201; P = .000) compared with other time periods throughout the day and (2) Massachusetts General Hospital on Sunday (adjusted OR: 1.09; P = .000) compared with other days of the week.
  
  
  CONCLUSIONS
  Insurance status appears to influence transfer patterns.
authors.affiliation: Department of Neurologic Surgery, The Mayo Clinic, Rochester, Minnesota 55905, USA. babu.maya@mayo.edu
authors.forename: Maya A
authors.initials: MA
authors.lastname: Babu
authors.forename: Brian V
authors.initials: BV
authors.lastname: Nahed
authors.forename: Marc A
authors.initials: MA
authors.lastname: Demoya
authors.forename: William T
authors.initials: WT
authors.lastname: Curry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000150:complications / Q000191:economics* / Q000628:therapy*; D016208:Databases, Factual; D004632:Emergency Medical Services; D005006:Ethnicity; D005260:Female; D015600:Glasgow Coma Scale; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000191:economics* / Q000706:statistics & numerical data; D007883:Legislation, Medical; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010360:Patient Transfer / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012042:Registries; D012959:Socioeconomic Factors; D013781:Texas / Q000453:epidemiology; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult