Background: In the United States, the Emergency Medical Treatment
and Active Labor Act defines broad guidelines regarding interhospital transfer
of patients who have sought care in the emergency department. However, patient
transfers for nonmedical reasons are still considered a common practice. The
purpose of this study was to evaluate the possible risk factors for hospital
transfer in a population of patients unlikely to require transfer to a level-I
center for medical reasons.
Methods: A retrospective case-control national database study was
performed with use of data from the National Trauma Data Bank (version 4.3).
The study group consisted of patients with low Injury Severity Scores (=9)
who were transferred to a level-I trauma center from another hospital. The
controls were patients with low Injury Severity Scores who were treated at any
hospital that was lower than a level-I trauma center and were not transferred.
Hypothesized risk factors for hospital transfer were the age, gender, race,
and insurance status of the patient; the time of day the transfer was
received; and the number and type of comorbidities.
Results: The total sample included 97,393 patients, 21% of whom were
transferred to a level-I trauma center. The odds ratios adjusted for all risk
factors indicated that transfer rates were higher for male patients compared
with female patients (adjusted odds ratio = 1.46), children compared with
seniors (3.54), blacks compared with whites (1.28), evening or night transfers
compared with morning or afternoon transfers (2.25), patients with Medicaid
compared with those with other types of insurance (2.02), and for those with
one or more comorbidities compared with those with no comorbidity (2.79).
Conclusions: These results suggest the need for prospective studies
to further investigate the relationships between hospital transfer and medical
and nonmedical factors.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.