Purpose
Level-I trauma centers are required to provide hand and microsurgery capability at
all times. We examined transfers to our center to better understand distant patient
referrals and, indirectly, study referrals in our region.
Methods
Records were reviewed from 2010 to 2015 to evaluate patients transferred to our level-I
institution for upper extremity amputation. Patients were referred from 6 states to
our institution over this period. We measured the straight-line distance from each
patient's transferring facility to our facility and compared this distance with the
straight-line distances from the zip code of the transferring facility to the zip
code of each level-I trauma center.
Results
We had data for 250 transferred patients (91% male, 9% female). For 110 patients (44%),
our hospital was the nearest level-I trauma center; however, for the remaining 140
patients (56%), other level-I trauma facilities were located closer to the referring
hospital. Among these 140 patients, the mean distance of the referring facility to
the nearest level-I trauma center (30 miles; SD, 27) was significantly different from
the mean distance of the referring facility to our facility (71 miles; SD, 60). A
median of 4 (range, 1–10) level-I trauma centers were bypassed before patients arrived
at our center. Medicaid and “self-pay” patients were more likely to be transferred
to our facility.
Conclusions
Fifty-six percent of patients transferred to our hospital for upper extremity amputation
had a level-I trauma center closer to their injury. Patients with upper extremity
amputation are referred to our regional center despite the proximity of closer level-I
trauma centers. This suggests that regional microsurgery expertise does not correlate
with level-I trauma designation, and establishment of designated microsurgery centers
and formal referral guidelines may be beneficial for management of these difficult
injuries.
Clinical relevance
We believe that this study further supports the need for formal designation of regional
centers of expertise for microsurgical hand trauma.
Key words
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Article info
Publication history
Published online: September 20, 2017
Accepted:
August 1,
2017
Received:
August 31,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
