Interinstitutional transfers to a trauma center

To determine patient demographics, referral patterns, and problems with trauma transfer, records of 412 patients received over a 1-year period at the Vancouver General Hospital, a Level I Trauma Center, were reviewed. The average Injury Severity Score (ISS) was 15 (range: 1 to 75), with 142 patients (34%) having an, ISS of 16 or greater. One hundred ninety-six (47%) of the transfers were accomplished by fixed-wing aircraft, 15 (4%) by helicopter, and 201 (49%) by land. Seventy-two percent were transported within 24 hours of injury. The injury mechanisms were as follows: 193 (47%) vehicular, 108 (26%) falls, 50 (12%) penetrating, 43 (10%) thermal, and 18 (5%) assaults/crush. Transfer was prompted by musculoskeletal injuries in 157 (38%), neurosurgical problems in 71 (17%), multiple injuries in 64 (16%), burns in 45 (11%), hand injuries in 27 (7%), facial injuries in 26 (6%), and other problems in 22 (5%). Transfer management problems, included airway in 4 patients, respiratory care in 8, and hemodynamic instability in 10. Only two of these patients had an ISS less than 16. Although most transfers were appropriate, some could have been avoided by more careful physician screening. For example, of six patients referred for digit replantation, only one was a suitable candidate. Lack of adequate regional care resulted in 10 long-distance air transports for isolated hip fractures. It is concluded that the majority of transfers were indicated and were safely carried out. However, there is a need for better patient screening, regionalized service, and improved communication regarding appropriate stabilization prior to transfer, particularly for patients with serious injuries.