Scoop and run to the trauma center or stay and play at the local hospital: Hospital transfer's effect on mortality

Ram Nirula, Ronald Maier, Ernest Moore, Jason Sperry, Larry Gentilello

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background: Triage attempts to ensure that severely injured patients are transported to a high-level trauma facility to reduce mortality. However, some patients are triaged to the nearest medical facility before transport to a final destination trauma center (TC). We sought to analyze whether initial triage of critically injured patients to a nontrauma center (NTC) is associated with increased mortality. Methods: The Glue Grant Trauma Database of severely injured patients was analyzed. Mortality risk for patients who had an intermediate stop at another facility was compared with patients triaged directly from the scene to the TC. Patient demographics, time from injury to TC arrival, resuscitation volume, transfusions, head injury, initial systolic blood pressure, co-morbidities, and injury severity were included as confounders in a multivariate logistic regression model. Results: There were 1,112 patients of whom 318 (29%) were initially triaged to an NTC. After adjusting for confounders, this was associated with an increase in prehospital crystalloids (4.2 L vs. 1.4 L, p < 0.05) and a 12-fold increase in blood transfusions (60% vs. 5%, p < 0.001). Age, injury severity score, Acute Physiology and Chronic Health Evaluation II score, and time from injury to TC arrival were independent predictors of mortality. The odds of death were 3.8 times greater (95% CI, 1.6-9.0) when patients were initially triaged to a nontrauma facility. Conclusions: Triaging severely injured patients to hospitals that are incapable of providing definitive care is associated with increased mortality. Attempts at initial stabilization at an NTC may be harmful. These findings are consistent with a need for continued expansion of regional trauma systems.

Original languageEnglish (US)
Pages (from-to)595-599
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume69
Issue number3
DOIs
StatePublished - Sep 2010

Fingerprint

Trauma Centers
Mortality
Wounds and Injuries
Triage
Logistic Models
Blood Pressure
Injury Severity Score
APACHE
Craniocerebral Trauma
Resuscitation
Blood Transfusion
Adhesives
Demography
Databases
Morbidity

Keywords

  • Delay
  • Mortality
  • Trauma center
  • Triage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Scoop and run to the trauma center or stay and play at the local hospital : Hospital transfer's effect on mortality. / Nirula, Ram; Maier, Ronald; Moore, Ernest; Sperry, Jason; Gentilello, Larry.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 69, No. 3, 09.2010, p. 595-599.

Research output: Contribution to journalArticle

Nirula, Ram ; Maier, Ronald ; Moore, Ernest ; Sperry, Jason ; Gentilello, Larry. / Scoop and run to the trauma center or stay and play at the local hospital : Hospital transfer's effect on mortality. In: Journal of Trauma - Injury, Infection and Critical Care. 2010 ; Vol. 69, No. 3. pp. 595-599.
@article{9ddf9b536615440e8acf36d5f6b9b658,
title = "Scoop and run to the trauma center or stay and play at the local hospital: Hospital transfer's effect on mortality",
abstract = "Background: Triage attempts to ensure that severely injured patients are transported to a high-level trauma facility to reduce mortality. However, some patients are triaged to the nearest medical facility before transport to a final destination trauma center (TC). We sought to analyze whether initial triage of critically injured patients to a nontrauma center (NTC) is associated with increased mortality. Methods: The Glue Grant Trauma Database of severely injured patients was analyzed. Mortality risk for patients who had an intermediate stop at another facility was compared with patients triaged directly from the scene to the TC. Patient demographics, time from injury to TC arrival, resuscitation volume, transfusions, head injury, initial systolic blood pressure, co-morbidities, and injury severity were included as confounders in a multivariate logistic regression model. Results: There were 1,112 patients of whom 318 (29{\%}) were initially triaged to an NTC. After adjusting for confounders, this was associated with an increase in prehospital crystalloids (4.2 L vs. 1.4 L, p < 0.05) and a 12-fold increase in blood transfusions (60{\%} vs. 5{\%}, p < 0.001). Age, injury severity score, Acute Physiology and Chronic Health Evaluation II score, and time from injury to TC arrival were independent predictors of mortality. The odds of death were 3.8 times greater (95{\%} CI, 1.6-9.0) when patients were initially triaged to a nontrauma facility. Conclusions: Triaging severely injured patients to hospitals that are incapable of providing definitive care is associated with increased mortality. Attempts at initial stabilization at an NTC may be harmful. These findings are consistent with a need for continued expansion of regional trauma systems.",
keywords = "Delay, Mortality, Trauma center, Triage",
author = "Ram Nirula and Ronald Maier and Ernest Moore and Jason Sperry and Larry Gentilello",
year = "2010",
month = "9",
doi = "10.1097/TA.0b013e3181ee6e32",
language = "English (US)",
volume = "69",
pages = "595--599",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Scoop and run to the trauma center or stay and play at the local hospital

T2 - Hospital transfer's effect on mortality

AU - Nirula, Ram

AU - Maier, Ronald

AU - Moore, Ernest

AU - Sperry, Jason

AU - Gentilello, Larry

PY - 2010/9

Y1 - 2010/9

N2 - Background: Triage attempts to ensure that severely injured patients are transported to a high-level trauma facility to reduce mortality. However, some patients are triaged to the nearest medical facility before transport to a final destination trauma center (TC). We sought to analyze whether initial triage of critically injured patients to a nontrauma center (NTC) is associated with increased mortality. Methods: The Glue Grant Trauma Database of severely injured patients was analyzed. Mortality risk for patients who had an intermediate stop at another facility was compared with patients triaged directly from the scene to the TC. Patient demographics, time from injury to TC arrival, resuscitation volume, transfusions, head injury, initial systolic blood pressure, co-morbidities, and injury severity were included as confounders in a multivariate logistic regression model. Results: There were 1,112 patients of whom 318 (29%) were initially triaged to an NTC. After adjusting for confounders, this was associated with an increase in prehospital crystalloids (4.2 L vs. 1.4 L, p < 0.05) and a 12-fold increase in blood transfusions (60% vs. 5%, p < 0.001). Age, injury severity score, Acute Physiology and Chronic Health Evaluation II score, and time from injury to TC arrival were independent predictors of mortality. The odds of death were 3.8 times greater (95% CI, 1.6-9.0) when patients were initially triaged to a nontrauma facility. Conclusions: Triaging severely injured patients to hospitals that are incapable of providing definitive care is associated with increased mortality. Attempts at initial stabilization at an NTC may be harmful. These findings are consistent with a need for continued expansion of regional trauma systems.

AB - Background: Triage attempts to ensure that severely injured patients are transported to a high-level trauma facility to reduce mortality. However, some patients are triaged to the nearest medical facility before transport to a final destination trauma center (TC). We sought to analyze whether initial triage of critically injured patients to a nontrauma center (NTC) is associated with increased mortality. Methods: The Glue Grant Trauma Database of severely injured patients was analyzed. Mortality risk for patients who had an intermediate stop at another facility was compared with patients triaged directly from the scene to the TC. Patient demographics, time from injury to TC arrival, resuscitation volume, transfusions, head injury, initial systolic blood pressure, co-morbidities, and injury severity were included as confounders in a multivariate logistic regression model. Results: There were 1,112 patients of whom 318 (29%) were initially triaged to an NTC. After adjusting for confounders, this was associated with an increase in prehospital crystalloids (4.2 L vs. 1.4 L, p < 0.05) and a 12-fold increase in blood transfusions (60% vs. 5%, p < 0.001). Age, injury severity score, Acute Physiology and Chronic Health Evaluation II score, and time from injury to TC arrival were independent predictors of mortality. The odds of death were 3.8 times greater (95% CI, 1.6-9.0) when patients were initially triaged to a nontrauma facility. Conclusions: Triaging severely injured patients to hospitals that are incapable of providing definitive care is associated with increased mortality. Attempts at initial stabilization at an NTC may be harmful. These findings are consistent with a need for continued expansion of regional trauma systems.

KW - Delay

KW - Mortality

KW - Trauma center

KW - Triage

UR - http://www.scopus.com/inward/record.url?scp=77957554425&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957554425&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3181ee6e32

DO - 10.1097/TA.0b013e3181ee6e32

M3 - Article

C2 - 20838131

AN - SCOPUS:77957554425

VL - 69

SP - 595

EP - 599

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -