PORTLAND, Ore. – Oregon Health & Science University researchers have found that injured patients who initially present at smaller, mainly rural emergency departments fare better when transferred to hospitals with a higher level of care. This is the first study to demonstrate a survival benefit associated with the transfer process.   

Researchers with the Center for Policy and Research in Emergency Medicine at OHSU reviewed cases of 10,176 adults and children presenting to smaller, mostly rural trauma centers throughout Oregon from January 1998 through December 2003. The group included all patients entered into the Oregon State Trauma Registry, representing a wide range of ages and injuries. Of these patients, 37 percent were transferred to a larger trauma center from the emergency department. The study found early transfer resulted in lower death rates.

“We assumed this was the case,” said Craig Newgard, associate professor of emergency medicine in the OHSU School of Medicine, “but this is the first study to confirm the inherent risks in transferring critically ill patients are overcome by access to the staff and resources of a large trauma center.”

Interhospital transfers are resource intensive, especially in rural regions where patients may require transport over hundreds of miles, taking valuable time that can delay emergency treatments. Larger trauma centers, such as OHSU, have surgical specialists, intensive care units, residency programs, and immediate availability of ancillary services and operating rooms that smaller centers do not have.

“What this study doesn’t tell us is which patients benefit most from interhospital transfer,” said Newgard. “While transfer protocols exist for specific injuries, much of the time it is up to the individual provider to determine whether a patient will benefit from being transferred to a larger trauma center. The next step will be to develop criteria that could be used to identify patients early in the course of care who will benefit most from transfer to a larger trauma center.” 

The study was published in the most recent volume of The Journal of Trauma Injury Infection, and Critical Care.

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