Primary admission and secondary transfer of trauma patients to Dutch level I and level II trauma centers: predictors and outcomes

Claire R L van den Driessche; Charlie A Sewalt; Jan C van Ditshuizen; Lisa Stocker; Michiel H J Verhofstad; Esther M M Van Lieshout; Dennis Den Hartog; Dutch Trauma Registry Southwest

doi:10.1007/s00068-021-01790-1

Primary admission and secondary transfer of trauma patients to Dutch level I and level II trauma centers: predictors and outcomes

Eur J Trauma Emerg Surg. 2022 Jun;48(3):2459-2467. doi: 10.1007/s00068-021-01790-1. Epub 2021 Sep 29.

Authors

Claire R L van den Driessche¹, Charlie A Sewalt^{2

3}, Jan C van Ditshuizen¹, Lisa Stocker^{1

4}, Michiel H J Verhofstad¹, Esther M M Van Lieshout¹, Dennis Den Hartog¹; Dutch Trauma Registry Southwest

Collaborators

Dutch Trauma Registry Southwest:
J M van Buijtenen, P T den Hoed, T S C Jakma, G de Klerk, G R Roukema

Affiliations

¹ Trauma Research Unit, Department of Surgery, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
² Trauma Research Unit, Department of Surgery, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. c.sewalt@erasmusmc.nl.
³ Center for Medical Decision Making, Department of Public Health, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. c.sewalt@erasmusmc.nl.
⁴ Department of Anesthesiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.

Abstract

Purpose: The importance and impact of determining which trauma patients need to be transferred between hospitals, especially considering prehospital triage systems, is evident. The objective of this study was to investigate the association between mortality and primary admission and secondary transfer of patients to level I and II trauma centers, and to identify predictors of primary and secondary admission to a designated level I trauma center.

Methods: Data from the Dutch Trauma Registry South West (DTR SW) was obtained. Patients ≥ 18 years who were admitted to a level I or level II trauma center were included. Patients with isolated burn injuries were excluded. In-hospital mortality was compared between patients that were primarily admitted to a level I trauma center, patients that were transferred to a level I trauma center, and patients that were primarily admitted to level II trauma centers. Logistic regression models were used to adjust for potential confounders. A subgroup analysis was done including major trauma (MT) patients (ISS > 15). Predictors determining whether patients were primarily admitted to level I or level II trauma centers or transferred to a level I trauma center were identified using logistic regression models.

Results: A total of 17,035 patients were included. Patients admitted primarily to a level I center, did not differ significantly in mortality from patients admitted primarily to level II trauma centers (Odds Ratio (OR): 0.73; 95% confidence interval (CI) 0.51-1.06) and patients transferred to level I centers (OR: 0.99; 95%CI 0.57-1.71). Subgroup analyses confirmed these findings for MT patients. Adjusted logistic regression analyses showed that age (OR: 0.96; 95%CI 0.94-0.97), GCS (OR: 0.81; 95%CI 0.77-0.86), AIS head (OR: 2.30; 95%CI 2.07-2.55), AIS neck (OR: 1.74; 95%CI 1.27-2.45) and AIS spine (OR: 3.22; 95%CI 2.87-3.61) are associated with increased odds of transfers to a level I trauma center.

Conclusions: This retrospective study showed no differences in in-hospital mortality between general trauma patients admitted primarily and secondarily to level I trauma centers. The most prominent predictors regarding transfer of trauma patients were age and neurotrauma. These findings could have practical implications regarding the triage protocols currently used.

Keywords: Level; Major trauma; Outcome; Predictors; Transfer; Trauma center; Triage.

MeSH terms

Hospital Mortality
Humans
Injury Severity Score
Patient Transfer
Retrospective Studies
Trauma Centers*
Triage
Wounds and Injuries* / therapy