Rural hospital transfer patterns before and after implementation of a statewide trauma system

N. Clay Mann, Jerris R. Hedges, Richard J. Mullins, Mark Helfand, William Worrall, Andrew D. Zechnich, Donald D. Trunkey, Patricia A. Southard, Melanie Zimmer-Gembeck, Donna Rowland, Alice Rogers

Research output: Contribution to journalArticle

19 Scopus citations


Objective: To evaluate trauma transfer practices in rural Oregon before and after implementation of a state-wide trauma system. Methods: A pre- vs post-system implementation (historical control) analysis of trauma transfer practices was performed using a sample of rural ED trauma patients from 4 Level-3 and 5 Level-4 trauma hospitals. Medical records of patients with specific index injury diagnoses in 4 anatomic regions (head, chest, liver/spleen, and femur/open-tibia) were reviewed for a 3-year period before statewide trauma system implementation and 3 years after hospital trauma designation. Results: Of 1,057 patients entered into the database, 532 were evaluated during the pre-system period and 525 were evaluated during the post-system period. Overall, 47% had head injuries, 34% had chest injuries, 23% had femur/open-tibia injuries, and 12% had spleen/liver injuries. There were 142 (13%) patients with an injury in >1 index area. After trauma system implementation, there was a significant increase in the proportion of ED trauma patients transferred from Level-4 trauma hospitals (32% vs 68%, p <0.001), with a corresponding decrease in the number of hospital admissions to these facilities (63% to 29%, p <0.001). Significant increases in the proportion transferred from Level-4 trauma hospital EDs were noted for all index injury categories (p <0.001). Trauma patients presenting to Level-4 EDs were significantly more likely to be transferred to Level-2 facilities (66% vs 82%, p = 0.030), while patients at Level-3 facilities were significantly more likely to be transferred to Level-1 centers (2% vs 14%, p = 0.002) following trauma system implementation. Multiple logistic regression modeling indicated that implementation of the statewide trauma system was an independent predictor of rural trauma patient transfer from Level-4 hospitals, while transfers from Level-3 facilities were dependent on type of injury. Conclusion: Implementation of the Oregon statewide trauma system was associated with a redistribution of rural trauma patients tO trauma hospitals with greater therapeutic resources.

Original languageEnglish (US)
Pages (from-to)764-771
Number of pages8
JournalAcademic Emergency Medicine
Issue number8
Publication statusPublished - 1997



  • Outcomes
  • Patient transfer
  • Rural trauma
  • Trauma system

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Mann, N. C., Hedges, J. R., Mullins, R. J., Helfand, M., Worrall, W., Zechnich, A. D., ... Rogers, A. (1997). Rural hospital transfer patterns before and after implementation of a statewide trauma system. Academic Emergency Medicine, 4(8), 764-771.