Increased Mortality for Transferred Trauma Patients: Should Transfer Time Become the Next Quality of Care Indicator?

INTRODUCTION: Prehospital transport mode and time is correlated with trauma patient outcomes. The aim of our study is to evaluate the effect of transport time on nationwide outcomes for severely injured adults who were transferred to a higher level of care. METHODS: We analyzed 2017 to 2018 American College of Surgeons TQIP. Severely injured (Injury Severity Score greater than 15) adult trauma patients with interfacility transfer to a higher level of care were included. Patients with missing transport mode or transport time (time from emergency medical service dispatch to patient arrival at the receiving facility) were excluded. Outcome measures were 24-hour and in-hospital mortality. RESULTS: A total of 57,848 severely injured adults who were transferred to a higher level of care were identified. The mean age was 60 ± 20 years. Males accounted for 62%, and the median Injury Severity Score was 17 [16 to 24]. Median transfer time was 126 [92 to 172] minutes, and the most common transport mode was ground ambulance (73%), followed by helicopter ambulance (25%). Every 30-minute delay in transfer time beyond 90 minutes was independently associated with increased odds of 24-hour mortality (adjusted odds ratio 1.042, p = 0.002) and in-hospital mortality (adjusted odds ratio 1.077, p < 0.001). Receiving Level I trauma centers had longer transfer times (128 [94 to 174] vs 124 [88 to 172] minutes; p < 0.001) and higher 24-hour mortality (3.3% vs 2.6%; p < 0.001) and in-hospital mortality (11.2% vs 9.4%; p < 0.001) compared with receiving Level II trauma centers (Figure).Figure.: EMS, emergency medical services.CONCLUSION: Transfer time may be considered a quality-of-care indicator for trauma systems, and transport times for interfacility transferred patients should be kept below 90 minutes. Every half-hour delay in transport time beyond 90 minutes for interfacility transferred patients is associated with 4% and 8% increases in adjusted odds of 24-hour and in-hospital mortality, respectively.