{"doi":"10.1186/s12873-021-00487-3","title":"Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers","abstract":"<jats:title>Abstract</jats:title><jats:sec>\n                <jats:title>Background</jats:title>\n                <jats:p>Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers.</jats:p>\n              </jats:sec><jats:sec>\n                <jats:title>Methods</jats:title>\n                <jats:p>We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS &gt; 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit.</jats:p>\n              </jats:sec><jats:sec>\n                <jats:title>Results</jats:title>\n                <jats:p>We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (<jats:italic>n</jats:italic> = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS &gt; 15 were predicted to benefit from transportation to Level-1 centers (<jats:italic>n</jats:italic> = 26,522, 22%).</jats:p>\n              </jats:sec><jats:sec>\n                <jats:title>Conclusions</jats:title>\n                <jats:p>Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.</jats:p>\n              </jats:sec>","journal":"BMC Emergency Medicine","year":2021,"id":44748,"datarank":1.0567839798456606,"base_score":2.995732273553991,"endowment":2.995732273553991,"self_citation_contribution":0.4493598410330987,"citation_network_contribution":0.607424138812562,"self_endowment_contribution":0.4493598410330987,"citer_contribution":0.607424138812562,"corpus_percentile":null,"corpus_rank":null,"citation_count":19,"citer_count":19,"citers_with_citation_signal":14,"citers_with_endowment":14,"datacite_reuse_total":10,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":210132,"name":"Benjamin Y. Gravesteijn","orcid":null,"position":1,"is_corresponding":false},{"id":210133,"name":"Daan Nieboer","orcid":null,"position":2,"is_corresponding":false},{"id":29499,"name":"Ewout W. Steyerberg","orcid":"0000-0002-7787-0122","position":3,"is_corresponding":false},{"id":210134,"name":"Dennis Den Hartog","orcid":null,"position":4,"is_corresponding":false},{"id":210135,"name":"David Van Klaveren","orcid":null,"position":5,"is_corresponding":false},{"id":210131,"name":"Charlie A. Sewalt","orcid":"0000-0003-3270-4814","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"base_score":2.995732273553991,"endowment":2.995732273553991,"datacite_reuse_total":10,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"34362302","pmcid":"PMC8344140","openalex_id":"https://openalex.org/W3191825674","authors":[],"funders":[],"total_grants":0,"fwci":2.7966,"citation_percentile":0.90927673,"influential_citations":0,"citation_trend":[{"year":2022,"count":4},{"year":2023,"count":2},{"year":2024,"count":5},{"year":2025,"count":5},{"year":2026,"count":3}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://bmcemergmed.biomedcentral.com/track/pdf/10.1186/s12873-021-00487-3","host_type":"journal"},{"url":"https://bmcemergmed.biomedcentral.com/track/pdf/10.1186/s12873-021-00487-3","host_type":"GOLD"},{"url":"https://bmcemergmed.biomedcentral.com/track/pdf/10.1186/s12873-021-00487-3","host_type":"publisher"},{"url":"https://link.springer.com/content/pdf/10.1186/s12873-021-00487-3.pdf","host_type":"publisher"},{"url":"https://link.springer.com/article/10.1186/s12873-021-00487-3/fulltext.html","host_type":"publisher"},{"url":"https://doi.org/10.1186/s12873-021-00487-3","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/34362302","host_type":"repository"},{"url":"https://pure.eur.nl/en/publications/685603a4-ad97-44f1-add0-55311e611b2b","host_type":"repository"},{"url":"https://pure.amsterdamumc.nl/en/publications/0d39f09e-07fc-49e6-beec-8234bb789ab2","host_type":"repository"},{"url":"http://hdl.handle.net/1765/136048","host_type":"repository"},{"url":"http://hdl.handle.net/1765/136384","host_type":"repository"},{"url":"http://hdl.handle.net/1887/3277509","host_type":"repository"},{"url":"https://doaj.org/article/0f159c07dad34363bbc5e73448a3267d","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/8344140","host_type":"repository"},{"url":"http://repub.eur.nl/pub/136048","host_type":"repository"},{"url":"http://repub.eur.nl/pub/136384","host_type":"repository"},{"url":"https://hdl.handle.net/1887/3277509","host_type":"repository"},{"url":"https://pure.amsterdamumc.nl/files/142067588/Identifying-trauma-patients-with-benefit-from-direct-transportation-to-level-1-trauma-centers.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC8344140","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC8344140?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["Trauma 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