ED discharge after trauma transfer has increased over time: A single tertiary care center analysis

Regionalization of care and changes in hospital and provider networks have led to increased transfer of patients to an accredited trauma center. We aimed to identify trends in trauma transfers and injury patterns that are likely to result in tertiary center admission versus discharge from the emergency department (ED).

All patients transferred from 2014 to 2021 to a single level I tertiary trauma center were identified. Using demographic, encounter, and diagnosis coding data from our trauma registry, specific injuries were stratified based on body system or type of injury. Numbers of transfers by year were analyzed using Wilcoxon rank sum test and chi-squared or Fisher's exact test. Univariable and multivariable logistic regression was used to identify injury patterns that correlated with tertiary hospital admission/intervention or discharge from the ED.

9307 trauma transfer patients were included. On multivariable regression, thoracic or orthopedic injuries were less likely to result in discharge from the ED (OR 0.34, 95% CI 0.27-0.42; OR 0.33, 95%CI 0.28-0.39). GCS of < 14 was also associated with a decreased likelihood of discharge (OR 0.13, 95% CI 0.08-0.22). Soft tissue injuries, spinal injuries, and head injuries were more likely to be discharged from the ED without requiring admission (OR1.24, 95%CI 1.09-1.40; OR 1.68, 95%CI 1.43-2.00; OR 2.77, 95%CI 2.30-3.34). During the study period, odds ratio of transfer patients being discharged directly from the ED increased.

In parallel with a growing number of patient transfers over the study period, there was also a trend where patients were more likely to be discharged straight from the ED. An opportunity exists to develop transfer protocols to reduce some transfers for soft tissue injuries and certain spine/head injuries.