• Aleksandr Rozenberg, Timothy Danish, Viktor Y Dombrovskiy, and Todd R Vogel.
• Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
• J Emerg Med. 2017 Sep 1; 53 (3): 295-301.

BackgroundThe multilevel designation system given to U.S. trauma centers has proven useful in providing injury-level-appropriate care and guiding field triage. Despite the system, patients are often transferred to Level I trauma centers for higher-level care/specialized services.ObjectivesThe objective of this study is to assess whether there is a difference in outcomes of patients transferred to Level I centers compared with direct admissions.MethodsThe Nationwide Inpatient Sample was queried to identify patients involved in motor vehicle accidents, using International Classification of Diseases, Ninth Revision, Clinical Modification E-codes. Patients that were admitted to Level I trauma centers were identified using American College of Surgeons or American Trauma Society designations.ResultsThere were 343,868 patients that met inclusion criteria. Of these patients, 29.2% (100,297) were admitted to Level I trauma centers, 5.7% (5691) of which were identified as trauma transfers. The lead admitting diagnosis for transfers was pelvic fracture (11.5%). Caucasians were 2.62 times as likely to be transferred as African-Americans (confidence interval 2.32-2.97), and 3.71 times as likely as Hispanics (confidence interval 3.25-4.23). Despite transfer patients having higher adjusted severity scores and higher adjusted risk of mortality, there were no differences in mortality (p = 0.95).ConclusionsNationally, trauma transfers do not have an increase in mortality when compared with directly admitted patients, despite a higher adjusted severity of illness and higher adjusted risk of mortality.Copyright © 2017 Elsevier Inc. All rights reserved.

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