Abstract 335: Outcomes Analysis for Direct Transport to Trauma Centers Versus Transfer After Stabilization at Other Hospitals: Nationwide Population-Based Research in Taiwan

Abstract

Background: Major trauma remains a major disease with about ten-thousand death annually in Taiwan. Since Trunkey described the concept of “golden hour”, outcomes for trauma patients in different levels of hospitals and the influence of transferring to trauma centers after stabilization in first hospitals become of particular interest. Methods: From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2006 to 2008, all of the trauma patients were identified from the database by the ICD-9-CM system. ICD-MAP was used for calculating the Injury Severity Score as the variable controlling the disease severity. The patients of major trauma were defined as ISS more than fifteen. We used patients’ diagnosis in 2005 for calculating Charlson Comorbidity Index. And factors such as age, gender, preexisting co-morbidities and different hospital levels were adjusted in a logistic regression model for survival analysis. Results: There were 5912, 5611 and 5760 trauma patients admitted from emergency department from 2006 to 2008, and there were 2497 major trauma patients (ISS more then 15). The totally mortality rate was 12.49% (6.98% in the youngest group and 18.19% in the oldest group, P<0.01). After controlling the age, genders, co-morbidity and injury severity, the difference of mortality rates were significant in hospital levels. Compared with the risk in trauma centers, the risk of mortality is 1.58 times in non- trauma centers (P<0.01). In the oldest group (>60 year-old), the risk of mortality is 1.89 times in non-trauma centers (P<0.01). There is no significant difference in the mortality rates between transferred and non-transferred trauma patients. And, the mortality rates is higher in those areas without trauma centers (OR=1.72, P<0.01) Conclusions: Our results suggest major trauma patients should be sent to trauma centers for care, especially the elderly patients. And based on the non-significant difference in mortality rates between transferred and non-transferred patients, major trauma patients should be transferred to trauma centers after initial stabilization.