The Effect of Interhospital Transfer Time on Mortality in Severe Trauma Patients
Time during interfacillity transfer in severe trauma patients
Keywords:
interfacility transfer, multiple trauma, mortalityAbstract
Background
Trauma is a time-sensitive condition, with improved outcomes traditionally believed to occur when definitive care is delivered within the first 60 minutes, known as the “golden hour.” In Thailand, many severely injured patients initially receive treatment at rural hospitals before being transferred to trauma centers. This study aimed to assess how interhospital transfer time affects mortality rates among patients with severe trauma.
Methods
We conducted a retrospective cohort study using records from the Khon Kaen Trauma Center, Thailand, from January 2022 to December 2022. Severe trauma patients (Injury Severity Score [ISS] > 15) who were transferred from rural hospitals were identified. Transfer time from rural hospital to trauma center was the main exposure. The primary outcome was overall and 24-hour mortality.
Results
Among 776 severe trauma patients, those in the delayed transfer group had significantly lower overall mortality (12.92% vs. 22.61%, p = 0.002) and 24-hour mortality (5.26% vs. 10.73%, p = 0.012) than patients in the optimal transfer group. Delayed transfer was associated with higher Revised Trauma Score (RTS) and greater distance from the trauma center. In multivariable analysis, lower Trauma and Injury Severity Score (TRISS) and road traffic injury were independently associated with increased 24-hour mortality. Longer transfer time was associated with decreased 24-hour mortality, although this association was borderline significant (adjusted risk ratio [RR] 0.89; 95% confidence interval [CI], 0.79–1.00; p = 0.052).
Conclusion
Delayed transfer time was associated with lower mortality, suggesting that greater physiological patient stability and prolonged initial care at rural hospitals may reduce immediate mortality risk. These findings indicate that not all trauma patients benefit equally from rapid transfer and highlight the importance of assessing patient stability and transfer timing to optimize outcomes.
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