The influence of inter-hospital transfers on mortality in severely injured patients

Job F. Waalwijk*, Robin D. Lokerman, Pre-hosp Trauma Triage Res Collabo, Rogier van der Sluijs, Audrey A. A. Fiddelers, Dennis den Hartog, Luke P. H. Leenen, Martijn Poeze, Mark van Heijl

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Web of Science)
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Abstract

Purpose The importance of treating severely injured patients in higher-level trauma centers is undisputable. However, it is uncertain whether severely injured patients that were initially transported to a lower-level trauma center (i.e., undertriage) benefit from being transferred to a higher-level trauma center. Methods This observational study included all severely injured patients (i.e., Injury Severity Score >= 16) that were initially transported to a lower-level trauma center within eight ambulance regions. The exposure of interest was whether a patient was transferred to a higher-level trauma center. Primary outcomes were 24-h and 30-day mortality. Generalized linear models including inverse probability weights for several potential confounders were constructed to evaluate the association between transfer status and mortality. Results We included 165,404 trauma patients that were transported with high priority to a trauma center, of which 3932 patients were severely injured. 1065 (27.1%) patients were transported to a lower-level trauma center of which 322 (30.2%) were transferred to a higher-level trauma center. Transferring undertriaged patients to a higher-level trauma center was significantly associated with reduced 24-h (relative risk [RR] 0.26, 95%-CI 0.10-0.68) and 30-day mortality (RR 0.65, 0.46-0.92). Similar results were observed in patients with critical injuries (24-h: RR 0.35, 0.16-0.77; 30-day: RR 0.55, 0.37-0.80) and patients with traumatic brain injury (24-h: RR 0.31, 0.11-0.83; 30-day: RR 0.66, 0.46-0.96). Conclusions A minority of the undertriaged patients are transferred to a higher-level trauma center. An inter-hospital transfer appears to be safe and may improve the survival of severely injured patients initially transported to a lower-level trauma center.

Original languageEnglish
Pages (from-to)441-449
Number of pages9
JournalEuropean Journal of Trauma and Emergency Surgery
Volume49
Issue number1
Early online date1 Sept 2022
DOIs
Publication statusPublished - Feb 2023

Bibliographical note

Funding Information:
Members of the Pre-hospital Trauma Triage Research Collaborative (PTTRC) are: Koen W.W. Lansink (ETZ Hospital Tilburg), Mariska A.C. de Jongh (Netwerk Acute Zorg Brabant), Jens A. Halm, Georgios F. Giannakópoulos (Amsterdam University Medical Center), Michael J.R. Edwards (Radboud University Medical Center), Pierre M. van Grunsven (Veiligheidsregio Gelderland-Zuid), Nancy van der Waarden (Regionale Ambulance Voorziening Rotterdam-Rijnmond), Laura Esteve Cuevas (Regionale Ambulance Voorziening Zuid-Holland Zuid), Arjen Siegers (Regionale Ambulance Voorziening Ambulance Amsterdam-Amstelland, Regionale Ambulance Voorziening Zaanstreek-Waterland), Risco van Vliet (Regionale Ambulance Voorziening Brabant Midden-West, Regionale Ambulance Voorziening Brabant-Noord), and Rinske M. Tuinema (Regionale Ambulance Voorziening Utrecht).

Funding Information:
This study was partly funded by grants from the Netherlands Organisation for Health Research and Development (ZonMw; 80–84300-98–18555) and the Innovation Fund Health Insurers (3383).

Publisher Copyright:
© 2022, The Author(s).

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