Adrian T Billeter1, Frank B Miller1, Brian G Harbrecht1, Wanda Bowen1, Matthew J Stephens2, Gregory C Postel2, Jason W Smith1, Matthew Penta1, Royce Coleman3, Glen A Franklin1, Donald D Trunkey4, Hiram C Polk5. 1. Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA. 2. Department of Diagnostic Radiology, University of Louisville School of Medicine, Louisville, KY, USA. 3. Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, KY, USA. 4. Department of Surgery, Oregon Health Sciences University, Portland, OR, USA. 5. Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA. Electronic address: hcpolk01@louisvill.edu.
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.
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 traumapatients 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 traumapatients. However, the unnecessarily prolonged stay of low GCS patients in hospitals lacking neurosurgical care is inappropriate.
Authors: H Koami; Y Sakamoto; K C Yamada; T Matsuda; J Nishi; K Nakayama; R Sakurai; M Ohta; H Imahase; M Yahata; M Umeka; T Miike; F Nagashima; T Iwamura; S Inoue Journal: Eur J Trauma Emerg Surg Date: 2017-01-16 Impact factor: 3.693