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Association between transfer pathways and functional outcomes in severe trauma patients: a cohort study using the
Koshi Nakagawa1, Ryo Sagisaka2, Daigo Morioka3
1Department of Sport and Medical Sciences, Faculty of Physical Education, Kokushikan University, Japan; Graduate School of Emergency Medical System, Kokushikan University, Japan.
Objective:
Optimal transport strategies for severe trauma remain debated, particularly in Asia. We evaluated the association between interhospital transfer and functional outcome and its consistency across Asian trauma systems.
Methods:
This cohort study used the Pan-Asian Trauma Outcome Study (PATOS) registry. We analyzed patients with severe trauma (Injury Severity Score > 15) in South Korea, Malaysia, and Vietnam (2015-2022). The exposure was interhospital transfer (Transfer) versus direct transport to a definitive-care hospital (Direct). The primary outcome was a favorable functional outcome (modified Rankin Scale ≤3). The primary model was a country fixed-effect logistic regression estimating the total effect; country-specific estimates and a transport-pathway × country interaction were pre-specified.
Results:
Of 9857 patients (Direct, n = 6725; Transfer, n = 3132; 89.2% of transfers in South Korea), a favorable functional outcome occurred in 4701/6403 (73.4%) versus 1830/2991 (61.2%). Transfer was associated with lower odds overall (adjusted odds ratio [aOR] 0.86, 95% confidence interval [CI] 0.78-0.95), but estimates differed by country (South Korea 1.06, 0.95-1.18; Malaysia 0.53, 0.36-0.80; Vietnam 0.17, 0.11-0.25; interaction P < 0.001; I2 = 97.4%).
Conclusion:
Interhospital transfer was associated with a lower likelihood of a favorable functional outcome, but this was not uniform across the three trauma systems and was dominated by Korean data, in which no association was observed. These findings require confirmation in analyses anchored at injury or first medical contact.