Each year trauma injuries account for 42 million emergency department visits and 2 million hospital admissions across the nation. Timely care in a designated trauma center has been shown to reduce mortality by up to 25 percent. However many patients are not transferred to trauma centers if they are first seen in a non-trauma center facility. Now, researchers at the Perelman School of Medicine at the University of Pennsylvania and the Stanford University School of Medicine have found that patients with severe injuries initially evaluated at non-trauma center emergency departments are less likely to be transferred if they are insured. The new study is published online ahead of print today in JAMA Surgery.

The research team, led by M. Kit Delgado, MD, an instructor in the department of Emergency Medicine, Faculty Fellow in the Center for Epidemiology and Biostatistics and the Leonard Davis Institute of Health Economics at Penn, found that insured patients initially taken to a non-trauma center had a 11 to 14 percent higher rate of admission — and were likely at risk for receiving worse care than could be delivered at a trauma center — than uninsured patients.

Although a majority of severely injured trauma patients are initially brought to trauma centers, at least one-third are taken to non-trauma centers. In these cases, emergency room doctors must assess the injuries and decide whether to admit the patient or transfer them to a trauma center. Their decision usually depends on the injury — how severe it is, what the cause was, or whether the hospital has specialists to handle particular types of injuries.

“Doctors working in the trenches most often strive to do what's best for patients, but these findings are concerning and suggest that non-trauma centers are considering admitting some patients with life-threatening injuries based on whether or not they can be paid, when research has shown these patients fare better if transferred to a trauma center,” said Delgado, a former Stanford emergency medicine instructor. “This may point to the need for policies that would require shared reimbursement arrangements to offset the potential loss of reimbursement that non-trauma centers may experience in transferring rather than admitting insured trauma patients with critical injuries.”

The findings are based on an analysis of more than 4,500 trauma cases reported at 636 hospitals in a 2009 Nationwide Emergency Department Sample put together by the Agency for Healthcare Research and Quality.

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