• Adrian T Billeter, Frank B Miller, Brian G Harbrecht, Wanda Bowen, Matthew J Stephens, Gregory C Postel, Jason W Smith, Matthew Penta, Royce Coleman, Glen A Franklin, Donald D Trunkey, and Hiram C Polk.
• Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
• Am. J. Surg. 2014 Apr 1;207(4):459-66.

BackgroundStops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs).MethodsWe studied 754 consecutive blunt trauma patients with an Injury Severity Score greater than 20 with an emphasis on 212 patients who received care at other sites en route to our level 1 trauma center.ResultsReferred patients were older, more often women, and had more severe TBI (all P < .05). After correction for age, sex, and injury pattern, there was no difference in the type of TBI, Glasgow Coma Scale (GCS) upon arrival at the trauma center, or overall mortality between referred and directly admitted patients. GCS at the outside institution did not influence promptness of transfer.ConclusionsInterhospital transfer does not affect the outcome of blunt trauma patients. However, the unnecessarily prolonged stay of low GCS patients in hospitals lacking neurosurgical care is inappropriate.Copyright © 2014 Elsevier Inc. All rights reserved.

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