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Updated: Jun 23, 2026
Focused Assessment with Sonography for Trauma (FAST) Exam: Image Acquisition
Published on: September 22, 2023
Financial triage in transfer of trauma patients: a myth or a reality?
Jennifer Parks1, Larry M Gentilello, Shahid Shafi
1Department of Surgery, Division of Burns, Trauma and Surgical Critical Care, University of Texas Southwestern Medical School, Dallas, TX 75390-9158, USA.
Background:
It has been alleged that smaller hospitals transfer out uninsured trauma patients (wallet biopsy), putting the financial burden on major trauma centers.
Methods:
We undertook a retrospective analysis of the National Trauma Data Bank to compare patients who received care at major trauma centers after being transferred from another hospital (transfer group, n = 72,900) with patients who received definitive care at a smaller hospital (nontransfer group, n = 6,826).
Results:
Transfer patients were more likely to be uninsured (18% vs 14%; P < .001), but were more severely injured (Injury Severity Score, 11 +/- 10 vs 7 +/- 7; P < .001), or had multiple injuries. After adjustment for these differences, uninsured patients were no more likely to be transferred than insured ones (odds ratio, .95; 95% confidence interval, .88-1.04; P = .3).
Conclusions:
There was no relationship between lack of insurance and likelihood of transfer to a major trauma center.
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