title: Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome.
abstract: BACKGROUND
  Stops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs).
  
  
  METHODS
  We studied 754 consecutive blunt trauma patients with an Injury Severity Score greater than 20 with an emphasis on 212 patients who received care at other sites en route to our level 1 trauma center.
  
  
  RESULTS
  Referred patients were older, more often women, and had more severe TBI (all P < .05). After correction for age, sex, and injury pattern, there was no difference in the type of TBI, Glasgow Coma Scale (GCS) upon arrival at the trauma center, or overall mortality between referred and directly admitted patients. GCS at the outside institution did not influence promptness of transfer.
  
  
  CONCLUSIONS
  Interhospital transfer does not affect the outcome of blunt trauma patients. However, the unnecessarily prolonged stay of low GCS patients in hospitals lacking neurosurgical care is inappropriate.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: Adrian T
authors.initials: AT
authors.lastname: Billeter
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Miller
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Harbrecht
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: Wanda
authors.initials: W
authors.lastname: Bowen
authors.affiliation: Department of Diagnostic Radiology, University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Stephens
authors.affiliation: Department of Diagnostic Radiology, University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Postel
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Smith
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Penta
authors.affiliation: Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: Royce
authors.initials: R
authors.lastname: Coleman
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Franklin
authors.affiliation: Department of Surgery, Oregon Health Sciences University, Portland, OR, USA.
authors.forename: Donald D
authors.initials: DD
authors.lastname: Trunkey
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA. Electronic address: hcpolk01@louisvill.edu.
authors.forename: Hiram C
authors.initials: HC
authors.lastname: Polk
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
keywords: Head injuries; Imaging; Interhospital transfer; Referral; Trauma; Traumatic brain injury