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

Williams, Teresa A.; Finn, Judith; Fatovich, Daniel M; Jacobs, Ian

doi:10.3109/10903127.2013.804137

Cited by 30 publications

(30 citation statements)

References 76 publications

(54 reference statements)

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“…Trauma systems have been developed to improve patient outcomes and reduce the burden on society . These systems provide a multidisciplinary care strategy for seriously injured patients . The first step in the trauma system is prehospital care, which in metropolitan Australia is commonly delivered by paramedics.…”

Section: Introductionmentioning

confidence: 99%

“…5 These systems provide a multidisciplinary care strategy for seriously injured patients. 6 The first step in the trauma system is prehospital care, which in metropolitan Australia is commonly delivered by paramedics. The prevention of further injury, initiation of resuscitation and timely transport to an appropriate hospital facility are key objectives of the prehospital phase.…”

Section: Introductionmentioning

confidence: 99%

“…The prevention of further injury, initiation of resuscitation and timely transport to an appropriate hospital facility are key objectives of the prehospital phase. 6 Epidemiological trauma studies often exclude patients who died prehospital or are dead on arrival at hospital and are often restricted to major trauma. 2,7,8 Gaining an understanding of the epidemiology of trauma and paramedic management of injuries, may help inform clinical practice, enable better tailoring of paramedic education and improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia

Brown

Williams

Tohira

et al. 2018

Emerg Medicine Australasia

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia

Brown

Williams

Tohira

et al. 2018

Emerg Medicine Australasia

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“…9,10 However, these studies, mostly from developed countries are not generalizable, particularly in a resource poor settings such as in Malawi. There is a paucity of data on time to definitive care and outcomes following traumatic injury in sub Saharan Africa.…”

Section: Introductionmentioning

confidence: 99%

Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa

Boschini

Lu-Myers

Msiska

et al. 2016

Injury

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Introduction Traumatic injuries account for the greatest portion of global surgical burden particularly in low-and middle-income countries (LMICs). To assess effectiveness of a developing trauma system, we hypothesize that there are survival differences between direct and indirect transfer of trauma patients to a tertiary hospital in sub Saharan Africa. Methods Retrospective analysis of 51,361 trauma patients within the Kamuzu Central Hospital (KCH) trauma registry from 2008 to 2012 was performed. Analysis of patient characteristics and logistic regression modeling for in-hospital mortality was performed. The primary study outcome is in hospital mortality in the direct and indirect transfer groups. RESULTS There were 50,059 trauma patients were included in this study. 6,578 patients transferred from referring facilities and 43,481 patients transported from the scene. The indirect and direct transfer cohorts were similar in age and sex. The mechanism of injury for transferred patients was 78.1% blunt, 14.5% penetrating, and 7.4% other, whereas for the scene group it was 70.7% blunt, 24.0% penetrating, and 5.2% other. Median times to presentation were 13(4–30) and 3(1–14) hours for transferred and scene patients, respectively. Mortality rate was 4.2% and 1.6% for indirect and direct transfer cohorts, respectively. A total of 8816 patients were admitted of which 3636 and 5963 were in the transfer and scene cohort, respectively. After logistic regression analysis, the adjusted in-hospital mortality odds ratio was 2.09 (1.24–3.54);p=0.006 for indirect transfer versus direct transfer cohort, after controlling for significant covariates. Conclusions Direct transfer of trauma patients from the scene to the tertiary care center is associated with a survival benefit. Our findings suggest that trauma education and efforts directed at regionalization of trauma care, strengthening pre-hospital care and timely transfer from district hospitals could mitigate trauma-related mortality in a resource-poor setting.

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“…A recent meta-analysis of IHT effects in trauma patients revealed an inconsistency in pooled estimated mortality rates between transfer and direct admission groups. 7 Successful development of regional pediatric trauma care systems has necessitated a more meticulous investigation into the factors associated with IHT of pediatric trauma patients. Previous studies have reported that trauma severity or medical insurance status were predictive factors of transfer to a trauma center.…”

Section: Introductionmentioning

confidence: 99%

The influence of age on transfer of pediatric trauma patients after initial transport to hospitals with a higher capacity for general emergency care

et al. 2019

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective:The aim of this study was to investigate factors associated with the decision to transfer, rather than admit, pediatric trauma patients who were initially transported to emergency departments with a high capacity for general emergency care (regional emergency centers, RECs). Methods: In this retrospective analysis of the 2014 emergency medical services (EMS) sample of injured pediatric patients, we included injured patients below 19 years of age who were transported by EMS to an REC. The main exposure variable was age, which was categorized into four groups by 5-year intervals. The primary outcome was the emergency department (ED) disposition of the patients (admission versus transfer). A multivariable logistic regression analysis was conducted to estimate the effect of age group on ED disposition. Results: Data from 2,031 patients were analyzed. The transfer rate was 49.5%. In a univariate analysis, no statistically significant associations were found between severity or age group and ED disposition (19.9% vs. 18.6%, P=0.76; 20.1% vs. 16.8%, P=0.49; respectively). After adjusting for potential covariates, age group had a significant effect on transfer. When compared to 15-19 years old, the younger age groups had higher adjusted odds ratios (aORs) for transfer (0-4 years old, aOR 7.65 [95% CI, 1.24 to 47.38]; 5-9 years old, aOR 14.48 [95% CI, 2.08 to 100.55]; 10-14 years old, aOR 5.03 [95% CI, 10.5 to 26.79]). Conclusion: Younger pediatric patients with moderate to severe trauma are more likely to be transferred to another hospital despite initial transportation to a REC.

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

Cited by 30 publications

References 76 publications

Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia

Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia

Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa

The influence of age on transfer of pediatric trauma patients after initial transport to hospitals with a higher capacity for general emergency care

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