Comparing outcomes between patients transferred from a critical access hospital versus directly from scene to a level 1 trauma center - 28/08/22

Doi : 10.1016/j.amjsurg.2022.01.034

Esha Singhal ^a, Tiffany Xu ^a, Chathurika S. Dhanasekara ^c, Hasan Almekdash ^b, Destiny Anamege ^a, Jenny Lazarus ^c, Adel Alhaj-Saleh ^c, Amber Tucker ^c, Sharmila Dissanaike ^c,^⁎
^a Texas Tech University Health Sciences Center School of Medicine, TTUHSC, Lubbock, TX, USA
^b Clinical Research Institute, TTUHSC, Lubbock, TX, USA
^c Department of Surgery, UMC, Lubbock, TX, USA

^∗Corresponding author. Texas Tech University Health Sciences Center, Department of Surgery, 3601 4th St Stop 8312, Lubbock, TX, 79430-8312, USA.Texas Tech University Health Sciences CenterDepartment of Surgery3601 4th St Stop 8312LubbockTX79430-8312USA

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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Highlights

•	Initial stabilization of trauma patients at critical access hospital benefits.
•	Patient demographics associated with outcomes.
•	Longer length of stay in critical access hospital had increased survival.
•	Overall clinical outcomes between transfer groups were the same.
•	Existing trauma system protocols in West Texas are functioning well.