title: Interhospital transfer of liver trauma in New Mexico: a state of austere resources.
abstract: BACKGROUND
  There is debate in the trauma literature regarding the effect of prolonged prehospital transport on morbidity and mortality. This study analyzes the management of hepatic trauma patients requiring surgery and compares the outcomes of the group that was transferred to the University of New Mexico Hospital (UNMH) from outside institutions, to the directly admitted group.
  
  
  METHODS
  The UNMH Trauma Database was queried from 2005-2012. Of 674 patients who sustained liver injuries, 163 required surgery: 46 patients (28.2%) underwent interhospital transfer, and 117 (71.8%) were directly admitted. Variables examined included transfer status, trauma mechanism, transport type, injury severity score (ISS), liver injury grade, and associated injuries. Outcome variables included length of stay (LOS) and 30-day mortality. Outcomes of the transfer group (TG) and direct admit group (DAG) were compared.
  
  
  RESULTS
  Both TG and DAG had the same median age (31 y, P = 0.33). The blunt-to-penetrating ratio was the same for each group (48% blunt: 52% penetrating, P = 1.0). Median ISS was 25 for the TG and 26 for the DAG. Grade III or higher injury occurred in 29 (63%) of the TG and in 68 (58%) of the DAG (P = 0.56). Median hospital LOS was 14 d for TG and 9 d for DAG (P = 0.15). Median intensive care unit LOS was 4 d for both groups (P = 0.71). Thirty-day mortality was 20% in each group (P = 0.27). Using a multiple logistic regression model for the outcome of mortality, only age, ISS, and liver injury grade, not transfer status or transport type, had a significant effect on mortality.
  
  
  CONCLUSIONS
  There was no significant difference in liver injury grade, ISS, LOS, and mortality between TG and DAG. In the patient population of our study, transfer status did not affect outcome.
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Nova
authors.initials: N
authors.lastname: Szoka
authors.affiliation: Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
authors.forename: Cristina
authors.initials: C
authors.lastname: Murray-Krezan
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Richard
authors.initials: R
authors.lastname: Miskimins
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Alissa
authors.initials: A
authors.lastname: Greenbaum
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: David
authors.initials: D
authors.lastname: Tobey
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Syed
authors.initials: S
authors.lastname: Faizi
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Sonlee
authors.initials: S
authors.lastname: West
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lu
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Thomas
authors.initials: T
authors.lastname: Howdieshell
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Gerald
authors.initials: G
authors.lastname: Demarest
authors.affiliation: Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico. Electronic address: inir@salud.unm.edu.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Nir
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D000328:Adult; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000293:injuries*; D008297:Male; D009516:New Mexico / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data*; D040841:Resource Allocation / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D055815:Young Adult
keywords: Hepatic trauma; Hepatobiliary surgeon; Liver injury; Mortality; Transport