Potentially Avoidable Spine Transfers to a Level I Trauma Center: A Five-Year Retrospective Analysis

Area of Science:

• Emergency medicine
• Neurosurgery
• Orthopedics

Background:

• Emergency physicians often transfer patients with spine pathology to specialized centers.
• Many transferred patients do not require advanced procedures or imaging at tertiary care facilities.
• These transfers strain resources and impact patient access to local care.

Purpose of the Study:

• To evaluate the necessity of interfacility transfers for spine evaluations.
• To identify characteristics of patients who could potentially be managed at a lower level of care.
• To understand the resource implications of unnecessary spine transfers.

Main Methods:

• Retrospective cohort study of 1,918 spine evaluation transfers over five years.
• Defined transfer necessity based on operating room intervention, neurologic MRI, ICU admission, or surgical/neurology service admission.
• Analyzed patient disposition, emergency department length of stay, and specific spinal conditions.

Main Results:

• 32.2% of spine transfers were deemed potentially avoidable.
• Only 3.3% of transfers underwent surgery within 12 hours; 45.7% received a neurologic MRI.
• Patients with cervical spine fractures, lumbar spine/sacrum/coccyx fractures, or disc disorders were less likely to require tertiary care.

Conclusions:

• A significant portion of spine transfers are potentially avoidable, contributing to prolonged emergency department stays.
• Developing criteria to identify patients not requiring tertiary care is crucial.
• Further research should focus on managing these patients in community settings to optimize healthcare resources.