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Comparing outcomes between patients transferred from a critical access hospital versus directly from scene to a level 1 trauma center.

Singhal E, Xu T, Dhanasekara CS, Almekdash H, Anamege D, Lazarus J, Alhaj-Saleh A, Tucker A, Dissanaike S. Comparing outcomes between patients transferred from a critical access hospital versus directly from scene to a level 1 trauma center. American journal of surgery. 2022 Sep 1; 224(3):828-833.

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Abstract:

OBJECTIVES: The aim of this retrospective study was to compare the outcomes of trauma patients directly transported to a level I trauma center (SCENE) versus those who were stabilized at a critical access hospital (CAH) and subsequently transferred. METHODS: Patients were grouped based on their transfer status, interventions performed at CAH and outcomes. Google Maps was used to calculate the distances from the location of injury (LOI). Each transfer group data was analyzed separately to examine associations of different factors on the outcomes. Outcomes were compared using univariate and multivariate analyses and propensity score matching analysis. RESULTS: There were 262 patients in SCENE and 684 in CAH. Compared to SCENE, CAH had higher rates of blunt injury and a greater distance from LOI, whereas lower ISS score and length of stay (LOS) (p  <  0.05). The majority of CAH group survived compared to SCENE (p  =  0.007). For both groups, baseline factors (e.g., age) were associated with outcomes (p  <  0.05). Interestingly, longer LOS in the CAH was associated with an increase in survival (p  =  0.009), whereas an increased number of CT/MRI performed was associated with increased LOS (p  <  0.05)., and an increased number of procedures was associated with longer LOS and ICU stay (p  <  0.05). After matching, the two groups had no significant differences in survival, LOS, or ICU stay (p  >  0.05). CONCLUSION: Equivalent overall clinical outcomes were seen in both groups, suggesting that existing trauma system protocols in the West Texas region are functioning well to select appropriate patients for each transfer modality. LEVEL OF EVIDENCE III: Retrospective Analysis.




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