Secondary overtriage in a statewide rural trauma system

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Background—Rural hospitals have variable degrees of involvement within the nationwide trauma system because of differences in resources and operational goals. “Secondary overtriage” refers to the patient who is discharged home shortly after being transferred from another hospital. An analysis of these occurrences is useful to determine the efficiency of the trauma system as a whole. Materials and methods—Data was extracted from a statewide trauma registry from 2007– 2012 to include those who were: 1) discharged home within 48h of arrival, and 2) did not undergo a surgical procedure. We then identified those who arrived as a transfer prior to being discharged (secondary overtriage) from those who arrived from the scene. Factors associated with transfers were analyzed using a logistic regression. Injuries were classified based on the need of a specific consultant. Time of arrival to ED was analyzed using 8-hour blocks, with the 7AM–3PM block as reference. Results—19,319 patients fit our inclusion criteria of which 1,897 (9.8%) arrived as transfers. Descriptive analysis showed a number of differences between transfers and non-transfers due to our large sample size. Thus, we examined variables that had more clinical significance using logistic regression controlling for age, ISS, the type of injury, blood products given, the time of arrival to initial ER, and whether a CT scan was obtained initially. Factors associated with being transferred were ISS>15, transfusion of PRBC’s, graveyard-shift arrivals, and neurosurgical, spine, and facial injuries. Patients having a CT scan were less likely to be transferred. Conclusions—Secondary overtriage may result from the hospital’s limited resources. Some of these limitations are the availability of surgical specialists, blood products, and overall coverage during the “graveyard-shift.” More liberal use of the CT scan may prevent unnecessary transfers.