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Appropriateness of Patient Transfer With Associated Orthopaedic Injuries to a Level I Trauma Center

Crichlow, Renn J MD*; Zeni, Amer MD*; Reveal, Greg MD*; Kuhl, Mitchell DO; Heisler, Jason DO; Kaehr, David MD*; Vijay, Palaniswamy PhD§; Musapatika, Dana L MS, MSc*

Journal of Orthopaedic Trauma: June 2010 - Volume 24 - Issue 6 - p 331-335
doi: 10.1097/BOT.0b013e3181ddfde9
Original Article

Objective: To prospectively evaluate the appropriateness, indications, risk factors, and epidemiology of patients with orthopaedic injuries transferred to a Level I trauma center.

Design: Prospective data were supplemented through chart review on all patients transferred to a Level I trauma center with orthopaedic injuries (n = 546) from January 1, 2007, to December 31, 2007. The accepting orthopaedic trauma surgeon evaluated the appropriateness of transfer by visual analog scale.

Setting: A Level I trauma center.

Participants: Patients transferred to the trauma center requiring orthopaedic trauma service involvement.

Main Outcome Measurements: Demographics and visual analog scale appropriateness scores were collected on each patient.

Results: The authors considered 16.5% of the cohort inappropriate transfers, 49.3% appropriate, and the remaining 34.2% were designated as intermediate. The transfers came from an emergency department physician in 81% of cases, an orthopaedic surgeon in 14% of cases, and 5% by general surgeon or internist. One hundred forty-eight cases transferred primarily as a result of orthopaedic injuries had an available orthopaedic surgeon on-call at the original institution. Sixty percent were transferred as a result of orthopaedic injury complexity, but only 39% of the 148 were evaluated by an actual orthopaedic surgeon before transfer. Lack of orthopaedic coverage at the referring hospital accounted for 27% of transfers.

Conclusions: A total of 16.5% of transfers were deemed completely inappropriate by the accepting orthopaedic traumatologist. Most transfers, both appropriate and inappropriate, were attributed to either complete lack of orthopaedic coverage or a lack of expertise at the referring center.

From the *OrthoIndy, Indianapolis, IN; †St. Cloud Orthopedics, St. Cloud, MN; ‡One Orthopaedics North East, Fort Wayne, IN; and §Fleming Island, FL.

Accepted for publication December 4, 2009.

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This study was presented in part at the Orthopaedic Trauma Association Annual Meeting in Denver, CO, 2008.

Reprints: Dana L. Musapatika, MS, MSc, 1801 N Senate Boulevard, #200, Indianapolis, IN 46202 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.