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

Area of Science:

• Emergency medicine
• Neurosurgery
• Orthopedic surgery

Background:

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

Purpose of the Study:

• To evaluate the necessity of inter-facility transfers for spine evaluations.
• To identify characteristics of potentially avoidable spine transfers.

Main Methods:

• Retrospective cohort study of spine transfers to a Level I trauma center (2017-2022).
• Defined transfer necessity based on operating room intervention within 12 hours, neurologic MRI, ICU admission, or admission to neurology/surgical services.
• Analyzed patient outcomes and diagnostic categories.

Main Results:

• Out of 1,918 transfers, 32.2% were potentially avoidable.
• Only 3.3% required immediate surgery; 45.7% had neurologic MRI; 36.6% admitted to neurology/surgery.
• Patients with cervical spine fractures, lumbar spine/sacrum/coccyx fractures, and disc disorders had lower rates of necessary transfers.

Conclusions:

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