Multiply injured patients being transferred or directly admitted to a level 1 trauma center: a retrospective analysis

Anna Wahle-Gerhardt, Marcel Winkelmann, Philipp Mommsen, Christian Krettek, Christian Zeckey

Resumen


Objectives:

To examine the outcome and mortality of primary and secondary admitted multiply injured patients who were admitted to a level-1 hospital in Germany.

 

Methods:

A retrospective analysis using the local database from January 2005 to December 2014was performed. Two main groups (primary admission [PA] and secondary admission [SA]) were built and subgroup analyses investigating the character of the transferring hospital (local vs. regional vs. supraregional) were performed. Outcome parameters included demographics, injury characteristics, ICU-related aspects such as ventilation time, transfusion requirements, posttraumatic complications such as ARDS, MODS as well as Glasgow Outcome Scale and Mortality

 

Results:

A total of 999 primary and secondary admitted patients, 863 primary admitted (group PA) and 136 secondary admitted (group SA) patients were identified. Patients in group SA came from local (43.3%), regional (39.7%) and supraregional Trauma Centers (16.9%). There is no negative effect on short-term outcomes for interhospital transport of multiply injured patients. Secondary admitted patients are more ill at the time of admittance but are not injured worse than the directly admitted ones. Secondary referral is not an independent risk factor for mortality; length of stay for both groups is similar and the outcome is equivalent.

 

Conclusions:

Patients transferred to our level-1 hospital are generally more ill (at time of admission) but have similar outcomes when compared to the directly admitted patients.


Palabras Clave


Ruchholtz S, Lefering R, Paffrath T, et al. Reduction in mortality of severely injured patients in Germany. Dtsch Arztebl Int 2008;105:225-31.

Celso B, Tepas J, Langland-Orban B, et al. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma 2006;60:371-8; discussion 8.

MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006;354:366-78.

Zellweger R, Wichmann MW, Ayala A, Stein S, DeMaso CM, Chaudry IH. Females in proestrus state maintain splenic immune functions and tolerate sepsis better than males. Critical care medicine 1997;25:106-10.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.

Baker SP, O'Neill B, Haddon W, Jr., Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187-96.

Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Critical care medicine 1995;23:1638-52.

Force ADT, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-33.

Artigas A, Bernard GR, Carlet J, et al. The American-European Consensus Conference on ARDS, part 2. Ventilatory, pharmacologic, supportive therapy, study design strategies and issues related to recovery and remodeling. Intensive Care Med 1998;24:378-98.

Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975;1:480-4.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81-4.

Hill AD, Fowler RA, Nathens AB. Impact of interhospital transfer on outcomes for trauma patients: a systematic review. J Trauma 2011;71:1885-900; discussion 901.

Jain SV, Bhamidipati CM, Cooney RN. Trauma transfers to a rural level 1 center: a retrospective cohort study. J Trauma Manag Outcomes 2016;10:1.

Kanakaris NK, Giannoudis PV. Trauma networks: present and

future challenges. BMC Med 2011;9:121.

Kahn JM, Linde-Zwirble WT, Wunsch H, et al. Potential value of regionalized intensive care for mechanically ventilated medical patients. Am J Respir Crit Care Med 2008;177:285-91.

Krumholz HM, Normand SL, Spertus JA, Shahian DM, Bradley EH. Measuring performance for treating heart attacks and heart failure: the case for outcomes measurement. Health Aff (Millwood) 2007;26:75-85.

Gunkel S, Konig M, Albrecht R, et al. [Deployment and efficacy of ground versus helicopter emergency service for severely injured patients. Analysis of a nationwide Swiss trauma center]. Unfallchirurg 2015;118:233-9.

Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O'Brien CR, Rubenfeld GD. Hospital volume and the outcomes of mechanical ventilation. N Engl J Med 2006;355:41-50.

Golestanian E, Scruggs JE, Gangnon RE, Mak RP, Wood KE. Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center. Crit Care Med 2007;35:1470-6.

Billeter AT, Miller FB, Harbrecht BG, et al. Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome. Am J Surg 2014;207:459-66.

Arthur KR, Kelz RR, Mills AM, et al. Interhospital transfer: an independent risk factor for mortality in the surgical intensive care unit. The American surgeon 2013;79:909-13.

Sampalis JS, Denis R, Frechette P, Brown R, Fleiszer D, Mulder D. Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. J Trauma 1997;43:288-95; discussion 95-6.

Rivara FP, Koepsell TD, Wang J, Nathens A, Jurkovich GA, Mackenzie EJ. Outcomes of trauma patients after transfer to a level I trauma center. J Trauma 2008;64:1594-9.

Yuan Z, Cooper GS, Einstadter D, Cebul RD, Rimm AA. The Association between Hospital Type and Mortality and Length of Stay: A Study of 16.9 Million Hospitalized Medicare Beneficiaries. Medical Care 2000;38:231-45.

Strauch U, Bergmans DC, Winkens B, Roekaerts PM. Short-term outcomes and mortality after interhospital intensive care transportation: an observational prospective cohort study of 368 consecutive transports with a mobile intensive care unit. BMJ Open 2015;5:e006801.

Droogh JM, Smit M, Absalom AR, Ligtenberg JJ, Zijlstra JG. Transferring the critically ill patient: are we there yet? Crit Care 2015;19:62.