Frequency and Predictors of Trauma Transfer Futility to a Rural Level I Trauma Center.

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Healthcare Resource Management

Background:

• Interfacility transfer of trauma patients with unsurvivable injuries can be a misuse of limited tertiary care resources.
• Identifying predictors of futile transfers is crucial for optimizing triage and management.

Purpose of the Study:

• To identify risk factors for and predict futile trauma transfers to a rural Level I trauma center.
• To evaluate the predictive power of the MGAP (Mechanism, Glasgow Coma Scale, Age, Arterial Pressure) score for futile transfers.

Main Methods:

• Retrospective study of 3368 interfacility trauma transfers from 2014 to 2019.
• Futility defined as death, hospice, or comfort care within 48 hours of transfer without intervention.
• Logistic regression identified predictors; MGAP score's predictive ability was assessed using AUROC.

Main Results:

• 1.1% (37/3368) of transfers were deemed futile.
• Older age and falls were common in futile transfers.
• Age, Glasgow Coma Scale, systolic blood pressure, and Injury Severity Score were significant predictors. MGAP demonstrated high predictive power (AUROC 0.864).

Conclusions:

• Futile transfers represent a small but significant proportion of trauma transfers.
• Predictive tools like MGAP scoring can objectively assess transfer necessity.
• Utilizing predictive tools can improve resource allocation and patient-centered care discussions, especially in resource-limited areas.