Featured in NEJM Journal Watch: Most Severe Trauma Cases Not Transferred

By the NEJM Journal Watch Editors

While insurance status may have played a role in the decision to not transfer patients to trauma centers, hospital capabilities and injury patterns were likely more influential, according to a JAMA Surgery study of some 4500 adults with injury severity scores above 15, less than half of whom were transferred.

Admission rather than transfer was more likely if the initial hospital was a metropolitan teaching hospital (26% higher adjusted absolute risk of admission), the patient had severe abdominal injuries (16% higher risk), or the patient had Medicaid, Medicare, private, or other insurance (14%, 13%, 11%, and 13% higher risks, respectively). Transfers were more likely if the initial hospital was rural or the patient had severe head and neck injuries.