Analysis of secondary trauma transfers within a Canadian regional trauma network: room for improvement?

Purpose: This study examines secondary trauma transfers of critically injured patients to an adult regional trauma centre in a mixed urban-suburban setting, to examine if these could be avoided through the provision of prehospital critical care at the scene of injury.

Methods: This is a cohort study of trauma activations at an adult regional trauma centre in Toronto, Canada, over a 5-year period. We included all secondary trauma transfers of patients who were either admitted to the ICU, had surgery within 4 h of arrival or died within 48 h of admission. Baseline demographics, injury data, geospatial data and interventions provided were extracted from the hospital's trauma registry.

Results: 659 cases met the inclusion criteria during the five-year study period. 364 (55%) patients underwent secondary transfer from non-trauma centres located in relatively close proximity of 80 km or less. Within this group, patients had a median injury severity score of 22 (IQR 16-29) and the mortality was 17%. 188 (52%) received at least one critical care intervention at the sending facility prior to secondary transfer to the trauma centre. The most frequently performed interventions were emergency anesthesia and intubation (37%), blood transfusion (27%), and finger and/or tube thoracostomy (13%).

Conclusion: A significant proportion of critically injured patients in our mixed urban-suburban trauma network are transferred from non-trauma hospitals in relatively close proximity to the trauma centre. Non-trauma hospitals frequently provide time-critical and life-saving interventions prior to secondary transfer. A prehospital critical care scene response for major trauma should be explored as an option to deliver critical care interventions at the scene, followed by direct transport to a trauma centre.