This study examines secondary trauma transfers of critically injured patients to an adult regional trauma centre in a mixed urban-suburban setting, to examine if these could be avoided through the provision of prehospital critical care at the scene of injury. This is a cohort study of trauma activations at an adult regional trauma centre in Toronto, Canada, over a 5-year period. We included all secondary trauma transfers of patients who were either admitted to the ICU, had surgery within 4h of arrival or died within 48h of admission. Baseline demographics, injury data, geospatial data and interventions provided were extracted from the hospital's trauma registry. 659 cases met the inclusion criteria during the five-year study period. 364 (55%) patients underwent secondary transfer from non-trauma centres located in relatively close proximity of 80km or less. Within this group, patients had a median injury severity score of 22 (IQR 16-29) and the mortality was 17%. 188 (52%) received at least one critical care intervention at the sending facility prior to secondary transfer to the trauma centre. The most frequently performed interventions were emergency anesthesia and intubation (37%), blood transfusion (27%), and finger and/or tube thoracostomy (13%). A significant proportion of critically injured patients in our mixed urban-suburban trauma network are transferred from non-trauma hospitals in relatively close proximity to the trauma centre. Non-trauma hospitals frequently provide time-critical and life-saving interventions prior to secondary transfer. A prehospital critical care scene response for major trauma should be explored as an option to deliver critical care interventions at the scene, followed by direct transport to a trauma centre.
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