Trauma Transfers Research Articles

Stabilization of Rural Multiple-Trauma Patients at Level III Emergency Departments Before Transfer to a Level I Regional Trauma Center

Study objective: To determine whether triage and stabilization of severely injured rural trauma victims in outlying Level III emergency departments before transfer to Level I trauma centers results in outcomes similar to national normative data. Design: Retrospective review of trauma transfers and deaths during a 4-year period. Setting: Two Level III EDs in rural, upstate New York and an urban Level I regional trauma center. Participants: Fifty multiple-trauma victims with a Trauma Triage Score (T-RTS) of ≤11 or less. Forty-three patients were stabilized before transfer, and 7 died in the rural Level III ED. Results: There were 45 blunt injuries and 5 penetrating injuries. Mean patient age was 34 years (range, 9 months to 97 years). The Revised Trauma Score (RTS) on admission to the Level III ED was calculated for each patient (median score, 5.97; interquartile range (IQR), 4.09 to 6.90), as was the ultimate Injury Severity Score (ISS) (median score, 23; IQR, 13 to 29). With TRISS methodology, probabilities of survival ( P s) and death ( P d) were calculated. Results were compared with the Major Trauma Outcome Study (MTOS) by use of current coefficients derived from Walker-Duncan regression analysis of MTOS data. The predicted number of deaths was 13.5, whereas the actual number was 12, Z statistic, –.7l0. There were two unexpected survivors and three unexpected deaths. The 43 patients who were stabilized and transferred had a median RTS of 5.97 (IQR, 4.30 to 6.90) and an ISS of 18 (IQR, 12 to 25). The median interval in the Level III ED before transfer was 1 hour 43 minutes (IQR, 1 hour 11 minutes to 2 hours 40 minutes). There were two unexpected survivors ( P s=.32, P s=.49) and 1 unexpected death ( P s=.52). The predicted number of deaths was 8.1, whereas the actual number was 5. The 7 patients who died in the rural Level III ED had a median RTS of 4.41 (IQR, 2.98 to 4.71) and a median ISS of 50 (IQR, 44 to 65). The median interval in the Level III ED before death was 42 minutes (IQR, 41 minutes to 1 hour 20 minutes). There were 2 unexpected deaths ( P s=.66, P s=.55). The predicted number of deaths was 5.4 whereas the actual number was 7. Conclusion: Triage and stabilization of severely injured rural trauma victims at Level III EDs before Level I transfer provide outcomes similiar to national results. Unexpected death of severely injured trauma victims remains a problem in rural Level III EDs. [Veenema KR, Rodewald LE: Stabilization of rural multiple-trauma patients at Level III emergency departments before transfer to a Level I regional trauma center. Ann Emerg Med February 1995;25:175-181.]

Outcome of patients with blunt trauma transferred after diagnostic or treatment procedures or four-hour delay

This study was conducted to assess the outcome of patients suffering multiple injuries from blunt trauma who were transferred to a Level I trauma center for definitive care after special diagnostic or treatment procedures (DTPs) or after a simple delay of four hours at a primary receiving hospital. Retrospective review of aeromedical registry data and clinical chart review. Aeromedical trauma transfers made during a four-year period were studied. The TRISS method was used to determine predicted survivals for DTP patients, patients transferred after a four-hour delay, and patients transferred promptly. The observed survival for 469 aeromedically transferred patients with blunt trauma was the same as that predicted by TRISS analysis (394 vs 392.5). Survival for 86 patients with DTP was also the same as predicted (62 vs 61.6). Outcomes for nonDTP patients and for 92 patients experiencing a delay in transport of four hours or more were also the same as predicted. Early versus delayed decision to transfer patients with blunt trauma did not appear to influence overall outcome. These data suggest that minor delays in recognizing the need to transfer patients with blunt injuries to a trauma center for definitive care may be offset by rapid, skilled transfer and highly specialized trauma care and support the hypothesis that regional trauma center care after initial evaluation and resuscitation elsewhere can be effective even when the timing of transfer is not ideal.