Which Patients Need Immediate Transfer to a Trauma Center?

Most trauma triage research has focused on patients transported to level I and II trauma centers. Little is known about the need for triage to higher levels of care in injured patients transported to nontertiary centers. Researchers retrospectively studied 12,183 adult patients in Oregon during a 6-year period who met criteria for entry into the state trauma system, were transported to 1 of 42 nontertiary hospitals (level III or IV trauma centers), and survived the emergency department visit.

The primary outcome measure was a composite of death within 3 days of presentation (3% of patients), need for major nonorthopedic surgery within 3 days (22%), and intensive care unit stay of 2 days or more (10%). In regression analysis, the following 5 …