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Interhospital transfer of severely injured trauma patients does not influence outcome

Wahle-Gerhardt A, Winkelmann M, Mommsen P, Krettek C, Zeckey C

Trauma Department, Hannover Medical School, Hannover, Germany. Department of General, Trauma and Reconstructive Surgery, Ludwig-Maximilians-Universität München, Múnich, Germany.

Objectives. To examine outcomes and mortality in multiple-injury patients initially admitted or transferred to a level-I trauma center in Germany and to analyze the reasons for transfers from other level hospitals.
Methods. Retrospective analysis of data recorded from January 2005 through December 2014. We compared 2 main groups: patients admitted directly to the level-I center and patients transferred from another center. We also analyzed transferred patients according to whether they came from local, regional or supraregional trauma centers. Demographic
information and trauma characteristics were collected. We also recorded variables related to management in the intensive care unit (eg, duration of ventilation, transfusion requirement), complications [eg, presence of Acute Respiratory Distress Syndrome or Multiple Organ Dysfunction Syndrome], Glasgow Outcome Scale, and mortality. The
reasons for transfer were extracted from the case histories and transfer protocols.
Results. A total of 999 cases were identified: 863 patients were admitted directly and 136 were transferred (from local centers, 43.3%; regional centers, 39.7%; supraregional centers, 16.9%). We identified no negative effects on short-term outcomes that could be attributed to interhospital transfers. Transferred patients had higher Acute Physiology and
Chronic Health Evaluation II scores on admission, but their injuries were not more severe than transferred patients’. Interhospital transfer was not independently associated with mortality, and the mean hospital stay and outcomes were
similar in the 2 groups. Reasons for transfer differed according to the timing of transfer and to type of trauma center (regional or local vs supraregional center).
Conclusions. Patients transferred to a level-I trauma center are generally more severely ill at the time of admission, but mortality and mean hospital stay are similar in directly admitted and transferred patients.

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