Predictors of Interfacility Transfer in Head and Neck Trauma: A National Trauma Data Bank Study

Traumatic head and neck (H/N) injuries frequently present to level III/IV trauma centers, yet many require care available only at higher-level facilities. This study aims to characterize transfer patterns in H/N trauma patients initially treated at level III/IV centers.

The National Trauma Data Bank was queried for adults with H/N trauma initially presenting to level III/IV trauma centers between 2007 and 2015. Univariate analysis compared cohort characteristics, while multivariate logistic regression identified independent predictors of transfer.

In total, 18,454 patients met inclusion criteria, of whom 5923 (32.1%) were transferred. Cut/piercing and striking injuries were associated with greater transfer odds (aOR: 1.328, 1.653), while motor vehicle trauma was associated with decreased odds (aOR: 0.845, 95% CI: 0.763-0.937). Transfer was associated with jaw dislocation (aOR: 1.871, 95% CI: 1.228-2.852) and H/N burns (aOR: 8.832, 95% CI: 7.131-10.940). Mandibular (aOR: 2.53, 95% CI: 2.19-2.93), skull base (aOR: 1.379, 95% CI 1.229-1.547), and malar/maxillary fractures (aOR: 1.314, 95% CI: 1.163-1.486) increased transfer odds, while nasal bone fracture decreased odds (aOR: 0.817, 95% CI: 0.741-0.901). Isolated H/N injury increased transfer odds (aOR: 1.379, 95% CI: 1.247-1.526). Transferred cohorts most commonly underwent diagnostic imaging and simple bedside procedures prior to transfer.

Interfacility transfer is driven primarily by injury patterns rather than physiologic instability, likely reflecting anticipated need for subspecialty surgical intervention. Understanding injury-specific transfer predictors may optimize trauma systems and resource utilization while ensuring timely specialized care.