Vital Signs Blog

Uninsured, severely injured patients more likely to be transferred to trauma centers

Hospitals that aren't designated trauma centers are more likely to transfer severely injured patients that lack insurance and admit ones that have coverage, according to a new study.

The findings, published online Wednesday in the journal JAMA Surgery, showed that patients covered under Medicaid were 14% more likely than the uninsured to be admitted rather than transferred to a trauma center. Privately insured patients were 11% more likely to be admitted rather than transferred compared with those without insurance.

The research suggests that a patient's ability to pay may be among the many factors that emergency department physicians are taking into consideration when deciding whether to transfer a patient to a trauma-care facility, according to study author Dr. M. Kit Delgado, an instructor at University of Pennsylvania's Department of Emergency Medicine.

Delgado said it's more likely that hospitals were transferring patients who lack insurance rather than holding onto insured patients for the sake of getting paid.

Either way, such occurrences had the potential of putting those with health coverage at higher risk of not receiving the best trauma care. Timely care in a designated trauma center reduces the overall risk of death rate by 25% compared to when it's provided at a non-trauma care facility, according to the findings of a 2006 study published in the New England Journal of Medicine.

“I think people are well-intentioned, and if you are a big urban hospital and you happen to have a neurosurgeon and a general surgeon, you feel that you can take care of these patients,” Delgado said. “But those doctors may not be aware of the literature that's shown over and over again that if you cared for in a designated trauma center, which goes through a very rigorous accreditation process, it contributes to better outcomes.”

Though insurance was a factor, the study found that emergency departments within an urban teaching hospital were 26% more likely than non-teaching hospitals to admit a patient. Also, a patient's age and the type of injury they suffered made a difference. Patients younger than age 35 who suffered head and neck injuries were transferred to a trauma center more often than older patients with abdominal wounds.

The study analyzed more than 4,500 emergency room trauma cases of patients between the ages of 18 and 64 who were seen at more than 600 non-trauma centers across the country. Of these cases, more than 54% of patients were admitted into a hospital. Data was obtained from the Agency for Healthcare Research and Quality's 2009 Nationwide Emergency Department Sample, the largest database emergency department encounter in the U.S.

Trauma is the leading cause of death for Americans under the age of 65, with accidents accounting for 38% of all deaths among people between ages 1 and 24, according to the Centers for Disease Control and Prevention.

Follow Steven Ross Johnson on Twitter: @MHSjohnson


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