An exploratory analysis of transfer times in a rural trauma system

BACKGROUND: Delays to definitive care are of particular concern in rural trauma systems, where prehospital times are significantly longer than average. AIMS: We evaluated for differences between transferring hospitals in the total time required to transport patients to definitive care, and analyzed for associations between transport times and outcomes. SETTINGS AND DESIGN: We employed a cross-sectional design to analyze Level One Trauma Center registry data on interfacility transfer of 3,303 acute trauma patients. MATERIALS AND METHODS: We calculated time in minutes from injury to definitive care (total elapsed time (TET)), and analyzed for associations between TET and both mortality and length of hospital stay at our center. We mapped hospitals and catchment areas to illustrate statistics by transferring hospital. STATISTICAL ANALYSIS: We employed analysis of covariance (ANCOVA) to analyze for the effect of TET and injury severity category upon hospital length of stay, and for the effects of TET and air transport as compared to ground transport. We evaluated for likelihood of in-hospital mortality using logistic regression. RESULTS: TET had little or no effect upon length of hospital stay or in-hospital mortality. The effect of injury severity upon both length of stay and mortality was progressively greater with each categorical increase in severity. Air transport as compared to ground transport was associated with mild increases in length of stay and likelihood of mortality. Mapping revealed spatial patterns that were not evident by statistical analysis alone. CONCLUSIONS: Mapping of geographic variations holds promise as a supplement to quantitative needs assessments of trauma systems in rural regions and developing countries.