
Safety 2010 Conference CMS

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Address *	1128 Clio Street, Honolulu, Hawaii
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Introduction: Trauma systems aim to provide definitive care to injured patients in a timely manner.  Geographical challenges and distance result in long prehospital and interfacility transfer times, but the impact on patient outcome has not been clearly established. We determined the impact of overall transfer time on patient outcome in Hawaii. 
Methods:  This is a 7-year retrospective study of Hawaiis trauma registry. We analyzed severe trauma patients [injury severity score (ISS) > 15] transferred within 24 hours of injury to the only regional trauma center.  An adjusted multivariate survival model was used to determine the impact of transfer time upon survival.  
Results:  Data on 606 consecutive patients meeting study criteria were reviewed.  The average transfer time for all patients was 8.1 hours, with an unadjusted mortality rate of 10.23%.  Non-survivors arrived to the trauma center 1.4 hours earlier, were 9 years older, more severely injured, and had lower GCS scores, and revised trauma scores. Risk-adjusted survival analysis demonstrated that longer transfer times were associated with decreased mortality.  In survivors, hospital and ICU lengths of stay were not significantly correlated with transfer times, although longer transfer times were associated with less chance of ICU admission.
Conclusions: These findings warrant prospective analysis to determine whether the observed transfer times for more critical patients were too prolonged to demonstrate a survival benefit and whether those patients with longer transfer times benefited from more aggressive pre-transfer resuscitation.

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