Rural Level III centers in an inclusive trauma system reduce the need for interfacility transfer
Daniel J Galanis1, Susan Steinemann, Linda Rosen
1From the Emergency Medical Services and Injury Prevention System Branch (D.J.G.), Hawaii State Department of Health, Honolulu, Hawaii; Department of Surgery, University of Hawaii John A. Burns School of Medicine and The Queen's Medical Center (S.S.), Honolulu, Hawaii; Department of Pediatrics (L.R.), University of Hawaii John A. Burns School of Medicine, Hawaii Health Systems Corporation, Honolulu, Hawaii; Emergency Medical Services and Injury Prevention System Branch (A.C.B.), Hawaii State Department of Health, Honolulu, Hawaii; and Trauma and Acute Care Surgery (W.B.), Scripps Memorial Hospital, La Jolla, California.
Background:
Development of Level III trauma centers in a regionalized system facilitates early stabilization and prompt transfer to a higher level center. The resources to care for patients at Level III centers could also reduce the burden of interfacility transfers. We hypothesized that the development and designation of Level III centers in an inclusive trauma system resulted in lower rates of transfer, with no increase in morbidity or mortality among the non-transferred patients.
Methods:
State trauma registry data from January 2009 through September 2015 were examined from five rural hospitals that transfer patients to our highest (Level II) trauma center and resource hospital. These five rural hospitals began receiving state support in 2010 to develop their trauma programs and were subsequently verified and designated Level III centers (three in 2011, two in 2013). Multivariate logistic regression was used to examine the adjusted odds of patient transfers and adverse outcomes, while controlling for age, gender, penetrating mechanism, presence of a traumatic brain injury, arrival by ambulance, and category of Injury Severity Score. The study period was divided into "Before" Level III center designation (2009-2010) and "After" (2011-2015).
Results:
7,481 patient records were reviewed. There was a decrease in the proportion of patients who were transferred After (1,281/5,737) compared to Before (516/1,744) periods (22% vs. 30%, respectively). After controlling for the various covariates, the odds of patient transfer were reduced by 32% (p < 0.0001) during the After period. Among non-transferred patients, there were no significant increases in adjusted odds of mortality, or hospitalizations of seven days or more, Before versus After.
Conclusions:
Development of rural Level III trauma centers in a regionalized system can significantly reduce the need for transfer to a remote, higher level trauma center. This may benefit the patient, family, and trauma system, with no adverse effect upon patient outcome.
Level Of Evidence:
Epidemiological, level III.
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