The Price of Success—The Scope of Potentially Avoidable Trauma Transfers

Introduction: Potentially avoidable trauma transfers can risk over-extending busy trauma centers and add additional costs to trauma care. We hypothesized that many transfers may be potentially avoidable and explored the characteristics associated with early discharge after transfer.

Methods: Using the 2021-2022 National Trauma Data Bank, we identified all trauma patients over 18-years-old transferred to a trauma center. We defined “potentially avoidable transfer” as those discharged alive <48hours of transfer. Unadjusted and adjusted analyses were performed. We used known industry and U.S. Accountability Office reports to estimate medical transportation costs.   

Results:  A total of 1,969,999 adults met inclusion criteria, 22% (439,684) of which were transferred. Transferred patients were mostly male (62% vs. 38%, p<.001), more severely injured (19% vs. 16%, p<.001), yet less likely to die (1.3% vs. 2.4%, p<.001). Of transferred patients, 31% (135,575) stayed <48hours, and 40% (54,555) of these were discharged from the ED. Injury patterns were associated with potentially avoidable trauma transfers in unadjusted analysis. (Figure) In adjusted analysis, transfers for isolated face or external injury were twice as likely to be discharged early (OR 2.77 & 2.15, respectively p<.001 for both). Estimates for the average charges for medical transportation alone exceeded $285 million annually, and admissions for these patients accounted for a cumulative 73,633 days annually.  

Conclusions: Many trauma transfers in the U.S. are potentially avoidable and are costly.  These findings speak to the need for the U.S. trauma system to further study how to optimize patient needs and resources.