Geographic Disparities in Re-triage Destinations Among Seriously Injured Californians

• Published in: Annals of surgery open 2023-03, Vol.4 (1), p.e270
• Main Authors: Furmanchuk, Al'ona, Rydland, Kelsey James, Hsia, Renee Y, Mackersie, Robert, Shi, Meilynn, Hauser, Mark William, Kho, Abel, Bilimoria, Karl Y, Stey, Anne M
• Format: Article
• Language: English
• ISSN: 2691-3593; 2691-3593
• DOI: 10.1097/AS9.0000000000000270

quantify geographic disparities in sub-optimal re-triage of seriously injured patients in California. Re-triage is the emergent transfer of seriously injured patients from the emergency departments of non-trauma and low-level trauma centers to, ideally, high-level trauma centers. Some patients are re-triaged to a second non-trauma or low-level trauma center (sub-optimal) instead of a high-level trauma center (optimal). This was a retrospective observational cohort study of seriously injured patients, defined by an Injury Severity Score > 15, re-triaged in California (2009-2018). Re-triages within one day of presentation to the sending center were considered. The sub-optimal re-triage rate was quantified at the state, regional trauma coordinating committees (RTCC), local emergency medical service agencies, and sending center level. A generalized linear mixed-effects regression quantified the association of sub-optimality with the RTCC of the sending center. Geospatial analyses demonstrated geographic variations in sub-optimal re-triage rates and calculated alternative re-triage destinations. There were 8,882 re-triages of seriously injured patients and 2,680 (30.2 %) were sub-optimal. Sub-optimally re-triaged patients had 1.5 higher odds of transfer to a third short-term acute care hospital and 1.25 increased odds of re-admission within 60 days from discharge. The sub-optimal re-triage rates increased from 29.3 % in 2009 to 38.6 % in 2018. 56.0 % of non-trauma and low-level trauma centers had at least one sub-optimal re-triage. The Southwest RTCC accounted for the largest proportion (39.8 %) of all sub-optimal re-triages in California. High population density geographic areas experienced higher sub-optimal re-triage rates.