Charles Mains, MD, FACS
Trauma Services Medical Director
Centura Health, United States
Disclosure information not submitted.
Constance McGraw, MPH
Clinical Epidemiologist
Injury Outcomes Network
Disclosure information not submitted.
.jpg "Kristin Salottolo, MPH photo")
Kristin Salottolo, MPH
Clinical Epidemiologist
St. Anthony Hospital
Lakewood, CO
Disclosure information not submitted.
Cecile D'Huyvetter, RN, MSN
Vice President of Trauma and EMS Strategy
Centura Health, United States
Disclosure information not submitted.
David Bar-Or, MD
Director of ION Research
Swedish Medical Center Cherry Hills Campus, United States
Disclosure information not submitted.
Title: Identifying Predictors of Transfer From a Rural Trauma Facility Among Blunt Splenic Injuries
Introduction: Rural trauma centers must expediently decide which patients with a blunt splenic injury (BSI) require immediate transfer to a higher level of care and who can be safely admitted; yet few studies report on BSI in a rural setting. The purpose of this study is to identify characteristics of patients with BSI used for admittance or transfer.
Methods: This retrospective descriptive study included trauma patients ≥18 years who had a BSI and initially received care at a Level III trauma center over 4.5 years (1.1.16-6.1.20). Patient demographics, injury severity, spleen radiology findings, and clinical characteristics were compared by decision to admit or transfer to a higher level of care ≤24 hours of injury.
Results: Of the 74 patients with a BSI, 36 (49%) were admitted and 38 (51%) were transferred to a Level I facility. Over a majority of patients were male (78%), were 25 (21-38) years old on average, most (84%) had no comorbidities, and 66% had been injured from a ski/snowboard accident. Transferred patients were significantly more likely to be female (34% vs. 8%, p=0.007), to have an abbreviated injury scale score (AIS) ≥3 of the chest (86% vs. 50%, p=0.001), to be younger (24 (21-29) years old vs. 28 (22.5-47), p=0.045), have a higher injury severity score (16 (16-21) vs. 13 (9-16), p=0.007), and an OIS grade ≥3 (84% vs. 31%, p< 0.001), in comparison to admitted patients. After adjustment, OIS grade ≥3 was the only predictor of transfer (OR:12.1, 95% CI: 3.9-37.3, p< 0.001). In the subset with OIS grades ≥3, transferred patients were more likely to be female (31% vs. 0%, p=0.04), to have been in a motor vehicle crash (MVC, 16% vs. 0%, p=0.31), nearly all had a head AIS score ≥3 (92% vs. 60%, p=0.16), did not experience hemodynamic instability prior to arrival (3% vs. 18%, p=0.16), and had a small hemoperitoneum on imaging (67% vs. 25%, p=0.11). Additionally, eight (26%) patients with OIS grade ≥3 had a blush on CT, with no significant differences between groups.
Conclusions: Our data suggests that patients transferred from a rural facility had an OIS grade ≥3 and were often females who had been in an MVC with more severe head injuries but were typically stable enough for transfer. Stratifying by OIS grade may assist rural trauma centers with better defining transfer criteria for solid organ injuries.