A review of secondary interfacility trauma transfers meeting provincial prehospital trauma triage guidelines

Abstract

Severely injured patients benefit from early identification and trauma centre treatment. Ontario has provincial prehospital trauma triage guidelines identifying patients who require direct trauma centre transport. Trauma patients not identified as meeting this provincial trauma triage standard are brought to the closest non-trauma hospital and may later be transferred to a trauma centre by a secondary interfacility transfer. Secondary interfacility transfers cause significant delays in receiving definitive care which have been associated with worse outcomes. The objective of this study was to determine the frequency that patients who underwent emergent secondary interfacility trauma transfer initially met prehospital trauma triage guidelines, as well as to assess the approximate delay to trauma centre care. Health record review of all injured patients undergoing interfacility transfer to a trauma centre by the provincial critical care transport organization in Ontario, Canada over a 1-year period. The primary outcome of interest was the frequency that patients met the triage standards and which specific criteria were satisfied. Times from patient arrival at the initial non-trauma hospital to initiation of interfacility transfer and from patient arrival at initial non-trauma hospital to arrival at trauma centre were calculated. A total of 460 were included in the study, 372 (80.8%) of whom met the prehospital triage standard. The largest missed criteria were age greater than 55years, high-risk motor vehicle collisions, and decreased Glasgow Coma Scale. The median time from initial hospital arrival to trauma centre was 5.7h for those patients requiring secondary interfacility transport. Patients who meet trauma triage criteria that end up undergoing secondary interfacility transfer experience significant delays. We recommend adding recreational vehicle collisions as a triage criterion. Emergency physicians should work with their local paramedic services to ensure severely injured patients are identified early to expedite transport.