Objectives: There is a perception, with mixed literary support, that patients are transferred from community hospitals to tertiary medical centers for non-clinical reasons (i.e., payor source, race/ethnicity, night/weekend hours). Over-triage risks a concentration of uncompensated care at tertiary medical centers and unequally burdens the trauma system. This study aimed to identify potential non-clinical factors associated with the transfer of injured patients to trauma centers.
Methods: Using the 2018 North Carolina State Inpatient Database, patients with a primary diagnosis of spine, rib, or extremity fractures, or traumatic brain injury were identified using ICD-10 code and admission type of “Urgent”, “Emergency”, or “Trauma”. Patients were divided into cohorts of “retained” (at community hospital) or “transferred” (level-1 or 2 verified trauma centers).
Results: 11,095 patients met inclusion criteria; 2,432 (21.9%) patients made up the transfer cohort. The mean injury severity score (ISS) for all retained patients was 2.2 (±0.9) and 2.9 (±1.4) for all transferred patients. The transfer cohort was younger (mean age 66 v 75.8), underinsured, rural, and admitted after 1700 (p < 0.001). There was similar significance across each primary diagnosis cohort.
Conclusion: Patients transferred to trauma centers were more likely to be underinsured, live in rural areas, and be admitted outside of normal business hours. These patients had longer lengths of stay and were discharged less frequently to a facility. Across all cohorts, similar ISS suggests that a portion of the transfers had injuries that could be managed at a community hospital. These transfers occurred primarily after hours, suggesting a need for more robust community hospital coverage and funding. Intentional triage of the injured patient encourages appropriate utilization of resources and is crucial to maintaining high-functioning trauma centers and systems.
