Critically injured patients often not transferred: Study

A study led by Salt Lake City-based University of Utah analyzed nearly 150,000 hospitalized patients with critical injuries and found that a majority of these patients are not transferred to an appropriate site of care. 

Transfers to higher-level care centers, such as level 1 or 2 trauma centers, is called secondary triage and often associated with improved patient outcomes. Secondary triage is not common, however, particularly among adults age 80 and older and patients with public health insurance coverage, the study found. 

The researchers examined 146,816 patient encounters at level 3 and non-trauma hospitals in 2019, with each patient receiving an injury severity score greater than 15, indicating a critical injury. Fifty-eight percent of those patients were not transferred to a level 1 or 2 trauma center. 

The study was published Aug. 27 in the Journal of the American College of Surgeons. 

One-third of severely injured trauma patients in the U.S. are first treated at level 3 or non-trauma centers, according to the researchers. 

Visiting a level 3 trauma center with a severe injury while requiring a higher-level of care nearly tripled the odds of not being transferred, the study found. Urban facilities also raised the nontransfer risk by more than five times. 

“We need to develop state systems that are inclusive of all hospitals so that every person, regardless of where they are, gets optimal care and is treated at the right place for their injuries,” Marta McCrum, MD, co-author and University of Utah professor, said in an Aug. 27 statement. 

“Trauma systems are decentralized and managed at the state level,” McCrum said. “Currently, less than half of states have secondary triage guidelines that help clinicians determine who should be transferred to a level 1 or level 2 trauma center.”

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