Primary admission and secondary transfer of trauma patients to Dutch level I and level II trauma centers: predictors and outcomes

Claire R.L. van den Driessche, Charlie A. Sewalt*, Dutch Trauma Registry Southwest, Jan C. van Ditshuizen, Lisa Stocker, Michiel H.J. Verhofstad, Esther M.M. Van Lieshout, Dennis Den Hartog

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Purpose: The importance and impact of determining which trauma patients need to be transferred between hospitals, especially considering prehospital triage systems, is evident. The objective of this study was to investigate the association between mortality and primary admission and secondary transfer of patients to level I and II trauma centers, and to identify predictors of primary and secondary admission to a designated level I trauma center. Methods: Data from the Dutch Trauma Registry South West (DTR SW) was obtained. Patients ≥ 18 years who were admitted to a level I or level II trauma center were included. Patients with isolated burn injuries were excluded. In-hospital mortality was compared between patients that were primarily admitted to a level I trauma center, patients that were transferred to a level I trauma center, and patients that were primarily admitted to level II trauma centers. Logistic regression models were used to adjust for potential confounders. A subgroup analysis was done including major trauma (MT) patients (ISS > 15). Predictors determining whether patients were primarily admitted to level I or level II trauma centers or transferred to a level I trauma center were identified using logistic regression models. Results: A total of 17,035 patients were included. Patients admitted primarily to a level I center, did not differ significantly in mortality from patients admitted primarily to level II trauma centers (Odds Ratio (OR): 0.73; 95% confidence interval (CI) 0.51–1.06) and patients transferred to level I centers (OR: 0.99; 95%CI 0.57–1.71). Subgroup analyses confirmed these findings for MT patients. Adjusted logistic regression analyses showed that age (OR: 0.96; 95%CI 0.94–0.97), GCS (OR: 0.81; 95%CI 0.77–0.86), AIS head (OR: 2.30; 95%CI 2.07–2.55), AIS neck (OR: 1.74; 95%CI 1.27–2.45) and AIS spine (OR: 3.22; 95%CI 2.87–3.61) are associated with increased odds of transfers to a level I trauma center. Conclusions: This retrospective study showed no differences in in-hospital mortality between general trauma patients admitted primarily and secondarily to level I trauma centers. The most prominent predictors regarding transfer of trauma patients were age and neurotrauma. These findings could have practical implications regarding the triage protocols currently used.

Original languageEnglish
Pages (from-to)2459-2467
Number of pages9
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number3
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
Author collaborator group Dutch Trauma Registry Southwest: J.M. van Buijtenen: Department of Surgery, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands. P.T. den Hoed: Department of Surgery, Ikazia Ziekenhuis, Montessoriweg 1, 3083 AN, Rotterdam, The Netherlands. T.S.C. Jakma: Department of Surgery, Albert Schweitzer Ziekenhuis, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands. G. de Klerk: Department of Surgery, Admiraal de Ruijter Ziekenhuis, ‘s-Gravenpolderseweg 114, 4462 RA, Goes, The Netherlands. G.R. Roukema: Department of Surgery, Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.

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