Interfacility Emergency Department Transfer for Midface Fractures in the United States

Area of Science:

• Trauma surgery
• Health services research
• Emergency medicine

Background:

• Interfacility hospital transfer for isolated midfacial fractures is common.
• However, these transfers are often not clinically indicated.
• This highlights a need to understand the drivers and costs associated with these transfers.

Purpose of the Study:

• To estimate the incidence of interfacility hospital transfers for isolated midface fractures.
• To identify risk factors associated with these transfers.
• To assess the associated healthcare costs.

Main Methods:

• Retrospective cohort study using the 2018 Nationwide Emergency Department Sample.
• Identified patients with isolated midface fractures.
• Analyzed hospital trauma center designation, patient demographics, medical history, injury characteristics, and emergency department charges.

Main Results:

• Over 161,000 midface fracture encounters, with 3.53% transferred.
• Nontrauma centers, Level III/II trauma centers, Le Fort fractures, orbital floor fractures, cerebrovascular events, and cervical spine injuries were significant predictors of transfer.
• Total nationwide emergency department charges exceeded $1.16 billion, with $97 million attributed to transferred patients.

Conclusions:

• While infrequent, transfers for isolated midface fractures incur substantial healthcare costs.
• Transfer predictors are multifactorial, potentially linked to access to specialized care.
• Implementing transfer necessity evaluations and outpatient specialist access could reduce costs.