Direct transport versus interhospital transfer of patients with severe head injury in Norway

Abstract

Patients with a severe head injury admitted directly to the neurosurgical department are more severely injured, more frequently get advanced medical treatment in the field, and are undergoing surgery earlier than transferred patients.

Outcomes of Different Health Care Contexts for Direct Transport to a Trauma Center versus Initial Secondary Center Care: A Systematic Review and Meta-analysis

“…Databases from other sources were used in nine studies 29,52,54,57,58,61-63, 66 Retrospective review of medical records was performed in five studies. 17,42,56,68,69 The majority of studies were conducted in single level I/II trauma centers and their catchment areas, but eight were multiple level I/II centers studies: three from the USA, 53,54,63 three from Canada 21,28,51 one from Italy 62 and one from Australia. 30 Four USA studies 67,70,71,83 and one Norwegian study 68 classed their catchment area as 'rural'.…”

“…Most of the studies (n=14, 47%) were from the USA 18,20,29,[53][54][55]57,60,63,64,67,[69][70][71] Three were from Canada, 21,28,51 six from Europe that included two from Norway, 17,68 two from the Netherlands, 58,82 one from Italy 62 and one from Switzerland, 65 four from Asia (Hong Kong, 42,66 Japan, 61 and Taiwan 56 ), two from Australia and New Zealand 30,59 and one from South Africa. 52 The mean age of patients varied between regions, from an overall median age of 27 years in the South African study 52 to 44.9 years for the direct group and 45.9 years for the transfer group in the three Canadian studies.…”

“…52 In Canada the trauma system varied by province. 21,28,51 Three-tiered systems were described in Europe, 17,58,68 and Australia. 30 Two-tiered systems were also described in Europe 62,65,82 and Japan.…”

“…Thirty studies 17,18,20,21,[28][29][30]42,51-71 met the selection criteria and were included in this systematic review. We excluded ten studies 72-81 because they included all trauma cases and did not describe the severely injured cohort and one study because of discrepancies in their data 33 We included the most recent paper of two published by Haas, 19,21 but performed a sensitivity analysis to examine the effect of including the 2010 paper rather than the 2012 paper.…”

“…12 Criteria to determine who to transport to a trauma center in the US include physiological signs, anatomy of injury, mechanism of injury, and conditions that require special consideration. 7,12,15 Many countries have developed similar 3-, 16,17 4-18-20 or 5-21 tiered trauma systems.…”