An analysis of transfers into designated trauma centers from referring institutions – the potential for virtual consultation to reduce transfers

Abstract

Introduction

Trauma care frequently happens in emergency departments (ED) outside of major trauma centers. Many injuries often exceed the specialty capabilities of referring hospitals, requiring transfer to larger trauma centers. However, the proportion of patients discharged home without admission from receiving facilities remains unclear, suggesting potential overutilization of transfers. We sought to determine the proportion of transfer patients that are discharged home from the receiving ED.

Methods

We studied patients ≥15 years captured in the Trauma Quality Improvement Program (TQIP) database who were transferred from a referring institution and were subsequently discharged home from the receiving ED without additional services planned.

Results

From 2020 to 2022, there were 744,623 patients ≥15 years of age, of which, 82,316 (11 %) were discharged home with (1 %) or without (99 %) additional services planned. The median age was 40 (26–60), and 70 % were male. The most common mechanism of injury was a collision (40 %), followed by falls (30 %). The median composite injury severity score was 5 (1–5). Serious injury by body region was most frequent for the craniomaxillofacial (11 %) followed by the thorax (5 %). Most of the transfers were to level 1 centers (85 %). The most frequently performed procedures were CT brain followed by a CT cervical spine, abdominal ultrasound, MRI cervical spine, hand laceration repair, ocular evaluation, scalp repair, forearm fracture reduction, assessment of ocular pressure, and MRI of the lumbar spine. The most frequent diagnoses were nasal fracture, orbital floor fracture, macular fracture, subdural hematoma, dental fracture, pneumothorax, rib fracture, hand laceration, burns, and vertebral fracture.

Conclusions

We found that approximately 1 in 9 patients transferred to a higher level of care are discharged home from the ED, with most requiring neurosurgical, ophthalmologic, dental and craniomaxillofacial services. These findings suggest that virtual communication technology could reduce unnecessary transfers and associated costs.