• Renn J Crichlow, Amer Zeni, Greg Reveal, Mitchell Kuhl, Jason Heisler, David Kaehr, Palaniswamy Vijay, and Dana L Musapatika.
• OrthoIndy, Indianapolis, IN, USA.
• J Orthop Trauma. 2010 Jun 1;24(6):331-5.

ObjectiveTo prospectively evaluate the appropriateness, indications, risk factors, and epidemiology of patients with orthopaedic injuries transferred to a Level I trauma center.DesignProspective data were supplemented through chart review on all patients transferred to a Level I trauma center with orthopaedic injuries (n = 546) from January 1, 2007, to December 31, 2007. The accepting orthopaedic trauma surgeon evaluated the appropriateness of transfer by visual analog scale.SettingA Level I trauma center.ParticipantsPatients transferred to the trauma center requiring orthopaedic trauma service involvement.Main Outcome MeasurementsDemographics and visual analog scale appropriateness scores were collected on each patient.ResultsThe authors considered 16.5% of the cohort inappropriate transfers, 49.3% appropriate, and the remaining 34.2% were designated as intermediate. The transfers came from an emergency department physician in 81% of cases, an orthopaedic surgeon in 14% of cases, and 5% by general surgeon or internist. One hundred forty-eight cases transferred primarily as a result of orthopaedic injuries had an available orthopaedic surgeon on-call at the original institution. Sixty percent were transferred as a result of orthopaedic injury complexity, but only 39% of the 148 were evaluated by an actual orthopaedic surgeon before transfer. Lack of orthopaedic coverage at the referring hospital accounted for 27% of transfers.ConclusionsA total of 16.5% of transfers were deemed completely inappropriate by the accepting orthopaedic traumatologist. Most transfers, both appropriate and inappropriate, were attributed to either complete lack of orthopaedic coverage or a lack of expertise at the referring center.

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