Waalwijk, Job F.;
Lokerman, Robin D.;
van der Sluijs, Rogier;
Fiddelers, Audrey A. A.;
den Hartog, Dennis;
Leenen, Luke P. H.;
Poeze, Martijn;
van Heijl, Mark
The influence of inter-hospital transfers on mortality in severely injured patients
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Medientyp:
E-Artikel
Titel:
The influence of inter-hospital transfers on mortality in severely injured patients
Beteiligte:
Waalwijk, Job F.;
Lokerman, Robin D.;
van der Sluijs, Rogier;
Fiddelers, Audrey A. A.;
den Hartog, Dennis;
Leenen, Luke P. H.;
Poeze, Martijn;
van Heijl, Mark
Erschienen:
Springer Science and Business Media LLC, 2023
Erschienen in:
European Journal of Trauma and Emergency Surgery, 49 (2023) 1, Seite 441-449
Sprache:
Englisch
DOI:
10.1007/s00068-022-02087-7
ISSN:
1863-9933;
1863-9941
Entstehung:
Anmerkungen:
Beschreibung:
<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Purpose</jats:title>
<jats:p>The importance of treating severely injured patients in higher-level trauma centers is undisputable. However, it is uncertain whether severely injured patients that were initially transported to a lower-level trauma center (i.e., undertriage) benefit from being transferred to a higher-level trauma center.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>This observational study included all severely injured patients (i.e., Injury Severity Score ≥ 16) that were initially transported to a lower-level trauma center within eight ambulance regions. The exposure of interest was whether a patient was transferred to a higher-level trauma center. Primary outcomes were 24-h and 30-day mortality. Generalized linear models including inverse probability weights for several potential confounders were constructed to evaluate the association between transfer status and mortality.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>We included 165,404 trauma patients that were transported with high priority to a trauma center, of which 3932 patients were severely injured. 1065 (27.1%) patients were transported to a lower-level trauma center of which 322 (30.2%) were transferred to a higher-level trauma center. Transferring undertriaged patients to a higher-level trauma center was significantly associated with reduced 24-h (relative risk [RR] 0.26, 95%-CI 0.10–0.68) and 30-day mortality (RR 0.65, 0.46–0.92). Similar results were observed in patients with critical injuries (24-h: RR 0.35, 0.16–0.77; 30-day: RR 0.55, 0.37–0.80) and patients with traumatic brain injury (24-h: RR 0.31, 0.11–0.83; 30-day: RR 0.66, 0.46–0.96).</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>A minority of the undertriaged patients are transferred to a higher-level trauma center. An inter-hospital transfer appears to be safe and may improve the survival of severely injured patients initially transported to a lower-level trauma center.</jats:p>
</jats:sec>