Study Finds Higher Death Rate for Severely Injured Patients Who Bypass Trauma Centers

Severely injured patients should be transported directly from the scene of an accident to a trauma center, even if it means bypassing a closer hospital, according to new research that shows this results in a nearly 25% lower death rate.

However, even though 80% to 85% of people in North America live within a 1-hour drive or flight of a trauma center, 30% to 60% of severely injured patients still are taken to the nearest hospital.

Researchers led by Avery B. Nathens, MD, PhD, FACS, MPH, trauma director at St. Michael’s Hospital in Toronto, identified 11,398 patients who were severely injured in Ontario between 2002 and 2007. Of those, 66% were transported directly to one of Ontario’s nine adult trauma centers and 30% were transferred to trauma centers after being assessed at the closest hospital.

Overall, 18% of the patients, or 2,065 people, died. Four percent of patients died before they could be transferred to a trauma center accounting for 22% of all deaths. Previous studies have not included those patients, so doctors have assumed the death rate is the same for people taken directly to trauma centers and those who are transferred after first being assessed at a non-trauma center

By considering the outcome of all patients, Nathens found the risk of dying is 24% greater if a patient first stops at a non-trauma center. His study will appear in the Journal of the American College of Surgeons.

About half of the patients died more than 2 and a half hours after arriving at a non-trauma center, suggesting that ways to identify these patients earlier and having more rapid access to ambulance service to transfer them might make a difference.

“Trauma centers save lives,” Nathens stated in a press release. “We … have to find innovative ways to make sure that hospitals and providers who receive these patients are equipped with the highest level of skills and resources to provide to provide optimal care and a means to transfer them as soon as possible.”

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