Abstract
BackgroundUndertriage of major trauma patients is unavoidable, especially in the trauma system of rural areas. Timely stabilization and transfer of critical trauma patients remains a great challenge for hospitals with limited resources. No definitive measure has been proven to improve the outcomes of patients transferred with major trauma. The current study hypothesized that regular feedback on inter-hospital transfer of patients with major trauma can improve quality of care and clinical outcomes.MethodThis retrospective cohort study retrieved data of transferred major trauma patients with an injury severity score (ISS) > 15 between January 2010 and December 2018 from the trauma registry databank of a tertiary medical center. Regular monthly feedback on inter-hospital transfers was initiated in 2014. The patients were divided into a without-feedback group and a with-feedback group. Demographic data, management before transfer, and outcomes after transfer were collected and analyzed.ResultsA total of 178 patients were included: 69 patients in the without-feedback group and 109 in the with-feedback group. The with-feedback group had a higher ISS (25 vs. 27; p = 0.049), more patients requiring massive transfusion (14.49% vs. 29.36%, p = 0.036), and less patients with Glasgow Coma Scale ≤8 (30.43% vs. 23.85%, p < 0.001). After adjusting for confounding factors, the with-feedback group was associated with a higher rate of blood transfusion before transfer (adjusted odds ratio [aOR]: 2.75; 95% confidence interval [CI]: 1.01–7.52; p = 0.049), shorter time span before blood transfusion (− 31.80 ± 15.14; p = 0.038), and marginally decreased mortality risk (aOR: 0.43; 95% CI: 0.17–1.09; p = 0.076).ConclusionThis study revealed that regular feedback on inter-hospital transfer improved the quality of blood transfusion.
Highlights
Undertriage of major trauma patients is unavoidable, especially in the trauma system of rural areas
After adjusting for confounding factors, the with-feedback group was associated with a higher rate of blood transfusion before transfer, shorter time span before blood transfusion (− 31.80 ± 15.14; p = 0.038), and marginally decreased mortality risk
This study revealed that regular feedback on inter-hospital transfer improved the quality of blood transfusion
Summary
Undertriage of major trauma patients is unavoidable, especially in the trauma system of rural areas. The current study hypothesized that regular feedback on inter-hospital transfer of patients with major trauma can improve quality of care and clinical outcomes. Inclusion of regional trauma centers into the trauma system may facilitate timely transfer of severely injured patients and decrease the overall mortality rate [3, 5,6,7]. Delayed transfer with inadequate initial resuscitation still poses a major issue, [8,9,10] and there is no room for improvement without feedback from the receiving hospital and specialists in trauma care. Despite nationwide coverage of the health insurance system, patients who suffer major trauma in rural areas need to be resuscitated and transferred to level I trauma centers. We retrospectively analyzed the quality of resuscitation, clinical outcomes, and impact of regular feedback in multiple trauma patients referred from regional hospitals
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