Impact of secondary transfer on patients with severe traumatic brain injury.
BACKGROUND
Within a trauma network in the Netherlands, neurosurgical facilities are usually limited to Level I hospitals. Initial transport to a district hospital of patients who are later found to require neurosurgical intervention may cause delay. The purpose of this study was to assess the influence on outcome and time intervals of secondary transfer in trauma patients requiring emergency neurosurgical intervention.


METHODS
In a 3-year period, all patients who sustained a severe traumatic brain injury and underwent a neurosurgical intervention within 6 hours after admission to a Level I trauma center were included. Patients were classified into two groups: direct presentation to the Level I trauma center (TC) group or requiring secondary transport after having been diagnosed for neurosurgical intervention in other hospitals (transfer group).


RESULTS
Eighty patients were included for analyses. Twenty-four patients in the transfer group had a better Glasgow Coma Scale on-scene but a higher 30-day mortality compared with patients who were primarily presented to the Level I trauma center (33% vs. 27%; p = 0.553). In the transfer group, time to operation was 304 minutes compared with 151 minutes in the TC group (p < 0.001). Most delay occurred during the initial trauma evaluation and the interval between the first computed tomography and the transfer ambulance departure at the referring hospital.


CONCLUSIONS
Patients requiring an emergency neurosurgical intervention appear to have a clinically relevant worse outcome after secondary transfer to a neurosurgical service. Therefore, patient care can probably be improved by better triage on-scene and standardized procedures in case of a secondary transfer.
Department of Surgery, Trauma Unit, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands. : p.joosse@amc.nl
Pieter
P
Joosse
Teun-Peter
TP
Saltzherr
Willem A M
WA
van Lieshout
Pieternel
P
van Exter
Kees-Jan
KJ
Ponsen
W Peter
WP
Vandertop
J Carel
JC
Goslings
D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D004638:Emergency Treatment; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010360:Patient Transfer / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers