O'Connell Robert S, Haug Emanuel C, Malasitt Pramote, Mallu Satya, Satpathy Jibanananda, Isaacs Jonathan, Mounasamy Varatharaj
Department of Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA, 23298-0153, USA.
Department of Orthopaedic Surgery, University of Virginia, 400 Ray C Hunt Dr, Charlottesville, VA, 22903, USA.
Eur J Orthop Surg Traumatol. 2018 May;28(4):551-554. doi: 10.1007/s00590-018-2134-x. Epub 2018 Jan 27.
Trauma patients are frequently transferred to a higher level of care for specialized orthopedic care. Many of these transfers are not necessary and waste valuable resources. The purpose of this study was to quantify our own experience and to assess the appropriateness of orthopedic transfers to a level I trauma center emergency department.
A retrospective review of orthopedic emergency department transfers to a level I trauma center was performed. Data collected included time of transfer, injury severity score (ISS), age, gender, race, orthopedic coverage at transfer institution, and insurance status. Two orthopedic trauma surgeons graded the appropriateness of transfer. A weighted logistic regression model was used to compare dependent and independent variables.
A total of 324 patient transfers were reviewed; 65 (20.1%) of them were graded as inappropriate. There was no statistically significant relationship between appropriateness of transfer and age, availability of orthopedic coverage, night/weekend transfer, or insurance status. Regression analysis showed that only ISS (OR 1.130, p = .008) and "polytrauma" (OR 25.39, p < .0001) designation were associated with increased odds ratio of appropriate transfer. The kappa coefficient for inter-rater reliability between the two raters was 0.505 (95% CI, 0.388-0.623) reflecting moderate agreement.
Inappropriate transfers create a significant medical burden to our health care system using valuable resources. Our study found similar results of inappropriate transfers compared to previous studies. However, we did not find a relationship between insurance status or nights/weekends and transfer appropriateness.
创伤患者经常被转至更高水平的医疗机构接受专业骨科治疗。其中许多转院并无必要，浪费了宝贵的资源。本研究旨在量化我们自己的经验，并评估将患者转至一级创伤中心急诊科进行骨科治疗的合理性。
对转至一级创伤中心急诊科的骨科患者进行回顾性研究。收集的数据包括转院时间、损伤严重程度评分（ISS）、年龄、性别、种族、转院机构的骨科覆盖情况以及保险状况。两名骨科创伤外科医生对转院的合理性进行评分。使用加权逻辑回归模型比较因变量和自变量。
共审查了324例患者转院情况；其中65例（20.1%）被评为不合理。转院合理性与年龄、骨科覆盖情况、夜间/周末转院或保险状况之间无统计学显著关系。回归分析表明，只有ISS（比值比1.130，p = 0.008）和“多发伤”（比值比25.39，p < 0.0001）与合理转院的比值比增加相关。两名评估者之间的评分者间信度kappa系数为0.505（95%可信区间，0.388 - 0.623），反映出中度一致性。
不合理的转院给我们的医疗系统带来了巨大的医疗负担，浪费了宝贵资源。我们的研究发现，与之前的研究相比，不合理转院的结果相似。然而，我们并未发现保险状况或夜间/周末与转院合理性之间存在关联。
