Study finds trauma transfers often exceed 2-hour state mandated window

Although more seriously injured trauma patients appear to reach care more quickly based on a recent study of injured patients in Illinois, the findings show that many other traumatically-injured individuals in the state are not transported as rapidly as their condition requires.

“This study demonstrates that in a state trauma system where transfer of patients thought to require a higher level of care is mandated to occur within 2 hours, the majority of transfers do not comply with this time standard. Despite this, the most seriously injured patients do appear to be reaching definitive care within that 2-hour time frame,” Marie L. Crandall, MD, MPH, of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues wrote in their study, according to a press release from Archives of Surgery, which published the report.

The Illinois state trauma system recommends patients who need to be transferred should reach definitive care within a 2-hour window.

For their study, Crandall and colleagues analyzed data from the Illinois state trauma registry from 1999 to 2003, which includes data from 64 trauma centers in the state. There were 22,447 transfers between the facilities during the study period for a transfer rate of about 10.4%. About 50% to 60% of the cases each year included information about the time to transfer, according to the release.

The researchers found an overall median or midpoint transfer time of about 2 hours and 21 minutes, with about 20% of transfers (4,502) occurring within 2 hours. For all the years studied, among patients transferred within 2 hours, Injury Severity Scores were significantly higher and more of them had undergone same-day operations compared to those whose transfers took longer, as noted in the release.

Furthermore, patients transferred within 2 hours were more likely to die, while those transferred after more than 2 hours died at rates similar to those for all trauma patients.

“These data suggest that, in this system, provider-determined transfer time that exceeds 2 hours has no adverse effect on patient outcome,” the researchers concluded. “It appears to accomplish recognition and rapid transport of the most seriously ill. This may obviate the need for onerous system mandates that are not feasible or have poor compliance.”

Among patients studied who were most commonly transferred were orthopedic cases and those with head injuries.

Reference:

Crandall ML, et al. Analysis of compliance and outcomes in a trauma system with a 2-hour transfer rule. Arch Surg. 2010;145:1171-1175.

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