Related Experiment Video
Updated: May 13, 2025
Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
Analysis of secondary trauma transfers within a Canadian regional trauma network: room for improvement?
Ryan McAleer1,2, Rachel Stephenson3, Melissa McGowan4
1Gold Coast University Hospital, Gold Coast, QLD, Australia.
Purpose:
This study examines secondary trauma transfers of critically injured patients to an adult regional trauma centre in a mixed urban-suburban setting, to examine if these could be avoided through the provision of prehospital critical care at the scene of injury.
Methods:
This is a cohort study of trauma activations at an adult regional trauma centre in Toronto, Canada, over a 5-year period. We included all secondary trauma transfers of patients who were either admitted to the ICU, had surgery within 4 h of arrival or died within 48 h of admission. Baseline demographics, injury data, geospatial data and interventions provided were extracted from the hospital's trauma registry.
Results:
659 cases met the inclusion criteria during the five-year study period. 364 (55%) patients underwent secondary transfer from non-trauma centres located in relatively close proximity of 80 km or less. Within this group, patients had a median injury severity score of 22 (IQR 16-29) and the mortality was 17%. 188 (52%) received at least one critical care intervention at the sending facility prior to secondary transfer to the trauma centre. The most frequently performed interventions were emergency anesthesia and intubation (37%), blood transfusion (27%), and finger and/or tube thoracostomy (13%).
Conclusion:
A significant proportion of critically injured patients in our mixed urban-suburban trauma network are transferred from non-trauma hospitals in relatively close proximity to the trauma centre. Non-trauma hospitals frequently provide time-critical and life-saving interventions prior to secondary transfer. A prehospital critical care scene response for major trauma should be explored as an option to deliver critical care interventions at the scene, followed by direct transport to a trauma centre.
Insights
Many critically injured patients are transferred between hospitals, even when close to a trauma center. Exploring prehospital critical care could improve outcomes by providing interventions at the scene.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Critical Care
Background:
- Secondary trauma transfers are common in urban-suburban settings.
- Critically injured patients often receive interventions at non-trauma centers before transfer.
Purpose of the Study:
- To examine secondary trauma transfers of critically injured patients.
- To determine if prehospital critical care at the scene could avoid these transfers.
Main Methods:
- Cohort study of trauma activations over 5 years.
- Included secondary transfers to an adult regional trauma center.
- Extracted demographics, injury data, and interventions from trauma registry.
Main Results:
- 55% of patients were transferred from non-trauma centers within 80 km.
- 17% mortality in this subgroup.
- 52% received critical care interventions (e.g., intubation, blood transfusion) before transfer.
Conclusions:
- A significant number of critically injured patients undergo secondary transfers from nearby non-trauma hospitals.
- Non-trauma hospitals provide essential interventions prior to transfer.
- Prehospital critical care at the scene should be explored to optimize patient management.
