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The Victorian major trauma transfer study.

Salomon Zalstein1, Peter Danne, David Taylor

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Inter-hospital transfers of major trauma patients reveal significant variability in timing and escorts, with junior doctors escorting the most severely injured, leading to higher mortality. Addressing escort quality is crucial for improving patient outcomes in Victoria's trauma system.

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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Healthcare Management

Background:

  • Inter-hospital transfer of major trauma patients is critical for definitive care.
  • Variability in transfer processes can impact patient outcomes.
  • Understanding transfer dynamics is essential for optimizing trauma systems.

Purpose of the Study:

  • To comprehensively examine inter-hospital transfers of major trauma patients.
  • To identify reasons for transfer, duration, escorts, interventions, and unexpected events.
  • To analyze factors influencing mortality risk during transfers.

Main Methods:

  • A detailed study of major trauma case transfers in Victoria, Australia (April 2003 - December 2004).
  • Involved 23 hospitals and 7 transfer/retrieval services.
  • Data collected via specifically designed forms from transferring/receiving hospitals and escorts.

Main Results:

  • 451 major trauma cases were analyzed (mean Injury Severity Score 22.2).
  • Transfers often originated from Regional/Metropolitan Trauma Services and terminated at Major Trauma Services.
  • Hospital Medical Officers (HMOs) escorted the most severely injured, associated with the highest mortality risk (OR 3.67).
  • Interventions like vasopressor use and intubation prior to transfer significantly increased mortality risk.
  • Cases escorted by referring hospital doctors had higher mortality (14.5%) compared to Mobile Intensive Care Ambulance (MICA) escorts (6.0%).

Conclusions:

  • Significant variability exists in transfer requests, times, escorts, and mortality risk.
  • The most severely injured patients were escorted by junior doctors (HMOs), correlating with the highest mortality.
  • Urgent review of activation criteria, responsiveness, and escort composition is needed.
  • The establishment of Adult Retrieval Victoria aims to address these identified concerns.