Outcomes of trauma patients: Direct transport versus transfer after stabilisation at another hospital Kuang-Yu Hsiao a,b , Leng-Chieh Lin a,b , Meng-Hua Chou a , Cheng-Chueh Chen c , Hwa-Chan Lee d , Ning-Ping Foo e,f,g , Chi-Jei Shiao h , I-Chuan Chen a,b , Cheng-Ting Hsiao a,i , Kai-Hua Chen i,j, * a Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan b Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan c Department of General Surgery, China Medical University Beigang Hospital, Yunlin, Taiwan d Department of Emergency Medicine, St. Joseph Hospital, Yunlin, Taiwan e Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan f Department of Environmental and Occupational health, College of Medicine, National Cheng Kung University, Tainan, Taiwan g Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan h Department of Emergency Medicine, Potz General Hospital, Chiayi, Taiwan i School of Medicine, Chang Gung University, Taoyuan, Taiwan j Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan Trauma is not only a medical problem but also a public health issue. Some accidents and trauma-associated fatalities can be averted by following basic injury prevention procedures, especially by passing laws to promote adherence to these procedures. 1 Further, the outcomes of trauma patients can be improved by establishing an adequate regional trauma system. 2,3 However, factors affecting outcomes may be different in different regions or countries. A study comparing patients who sustained trauma in metropolitan areas versus those in rural areas in Western Australia found that the time to providing definitive care as well as mortality rates differed in these two groups. 4 These results imply that the protocols employed for transport of trauma patients may not be the same for different situations or regions. Overall, the differences in patient outcomes may be influenced by various components, including prehospital care, ability of the hospital to care for trauma patients, protocols for inter- hospital transfer and prehospital transport. Prehospital care may vary with how the personnel are equipped, the available facilities and what interventions can be provided. These elements vary across countries, and, even more, across different areas of a country. In Taiwan, the emergency medical system (EMS) provides only basic and non-invasive prehospital care. Patients transported by EMS usually receive oxygen support, immobilisation and basic life support (BLS) as needed, but only a small percentage of patients receive advanced airway management, fluid resuscitation or medications. The latter services may be available only in major cities in which physicians are available on ambulances. In Taiwan, ground transport is usually the only means of transport in both rural and urban areas, with the exception of some specific cases, Injury, Int. J. Care Injured 43 (2012) 1575–1579 A R T I C L E I N F O Article history: Accepted 4 January 2012 Keywords: Emergency department Mortality Transport Trauma Outcome A B S T R A C T Background: In this study, we attempted to identify differences in the outcomes of patients with severe trauma who were directly transported to our hospital, and those who were stabilised initially at other hospitals in south-central Taiwan. Methods: We performed a prospective observational study to review the records of 231 patients with major trauma (Injury Severity Scores (ISS) >15) who visited our hospital’s emergency department from January 2010 to December 2010. Among these patients, 75 were referred from other hospitals. Logistic regression was performed to assess the effects of transfer on mortality. Results: Patients in the transfer group had a shorter interval between trauma and admission to the first hospital (25.3 min vs. 28.1 min), and the average interval between the two hospital arrivals was 138.3 min. Transfer from another hospital was not significantly correlated with mortality in this study (odds ratio: 1.124, 95% confidence interval: 0.276–4.578). Conclusion: In trauma patients with ISS > 15, there is no difference in mortality between those transferred from another hospital after initial stabilisation and those who visited our emergency department directly. ß 2012 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No. 6, West. Sec., Chia-Pu Road, Putz City, Chiayi County 61363, Taiwan. Tel.: +886 5 362 1000x2672; fax: +886 5 362 8175. E-mail address: karenkhchen@mail2000.com.tw (K.-H. Chen). Contents lists available at SciVerse ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y 0020–1383/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2012.01.004