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European Journal of Trauma and Emergency Surgery

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Open Access 29-09-2021 | Triage | Original Article

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

Authors: 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

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2022

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.

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Title: Primary admission and secondary transfer of trauma patients to Dutch level I and level II trauma centers: predictors and outcomes
Authors: 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
Publication date: 29-09-2021
Publisher: Springer Berlin Heidelberg
Keyword: Triage
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01790-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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