Abstract 358: Predictors for Not Transferring the Major Trauma Patients to Trauma Centers. A Nation-wide Population Based Research in Taiwan
Background: The predictors for not-transferring the major trauma patients to trauma centers were analyzed in a logistic regression model.
Methods: From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2006 to 2008, all of the trauma patients were identified from the database by the ICD-9-CM system. ICD-MAP 90 was used for calculating the Injury Severity Score as the variable controlling the disease severity. The patients of major trauma were defined as ISS more than fifteen. We used patients’ diagnosis one year before trauma admission for calculating Charlson Comorbidity Index. We set up the rule for transferring major trauma patients to trauma centers as (1)Triage class I & II or (2)ISS>25 or (3)age>55. Factors like age, genders, intubation, ICU admission, different SES levels and triage classifications were adjusted in a logistic regression model for finding out the predictors of “not transferring to trauma centers”.
Results: There were 5912, 5611 and 5760 trauma patients admitted from emergency department from 2006 to 2008, and there were 2497 major trauma patients (ISS more then 15). The totally mortality rate was 12.49% (6.98% in the youngest group and 18.19% in the oldest group, P<0.01). All the variables like age, genders, co-morbidity, injury severity, triage classifications and the SES were not the significant predictors for not transferring major trauma patients to the trauma centers. But, intubation and ICU admission in the first hospitals were significant predictors for not transferring the major trauma patients to the trauma centers. Compared with the patients not admitted to ICU, the odds ratio for “patients admitted to ICU” was 0.54 (OR=0.54, P< 0.001).
Compared with the patients were not intubated, the odds ratio for “patients who were intubated” was 0.65 (OR=0.65, P=0.013).
Conclusions: Our results hint that pre-hospital transfer protocols are important for sending major trauma patients to trauma centers. Based on our results, once the major trauma patients were intubated or admitted to ICU in the first regional hospitals, the patients got lower chance to be transferred to trauma centers.
- © 2013 by American Heart Association, Inc.