Should Hypotensive Trauma Patients Ever Be Transferred to a Trauma Center?

Many trauma patients present to nontrauma centers with emergency conditions. The Emergency Medical Treatment and Active Labor Act dictates that nontrauma centers attempt stabilization and provide appropriate transfer. Our goal was to determine whether there was a survival benefit in transferring hypotensive patients. The Tampa General Hospital trauma registry database was queried for adult trauma transfers from January 2012 to April 2018 including the first recorded systolic blood pressure (SBP) and other pertinent data. A manual chart review in hypotensive (SBP < 90) patients determined blood pressure at the time of transfer. Of the 3038 patients, 40 patients were hypotensive on arrival, with 40% (16) mortality. Eight of nine (88%) patients with SBP <70 on arrival, 3 of 11 (27%) with SBP 70 to 79, and 5 of 20 (25%) with SBP 80 to 89 died. The only survivor in the <70 group was normotensive at transport. Patients in these groups who were hypotensive at the time of transport died (4/4, 100%). Our data show no benefit in transferring patients with refractory hypotension at the time of transport; although the numbers are small, an SBP <70 should be considered prohibitive to transfer.