Less Than Half of Critical Trauma Patients Are Transferred to Level I Trauma Centers

A recent study highlights that in the United States, a significant gap exists in the transfer of severely injured trauma patients to specialized Level I trauma centers. The research, published in the Journal of the American College of Surgeons, reveals that approximately 33% of patients with severe injuries initially receive care at lower-level hospitals, such as Level III or non-trauma centers. Alarmingly, less than half of these patients are subsequently transferred to a Level I trauma center for more comprehensive care.

Trauma systems are organized into three verification levels set by the American College of Surgeons, with Level I centers providing the highest standard of trauma care. Level III centers are designed to serve communities lacking immediate access to higher-level facilities, often managing moderate injuries. However, patients with more severe injuries should be transferred promptly for optimal outcomes.

The study examined over 146,000 adult trauma cases with Injury Severity Scores greater than 15, indicating severe trauma. Findings showed that 58% of these cases were not transferred to higher-level trauma centers, even when clinically indicated. Risk factors influencing non-transfer included advanced age—patients 80 years and older had a 68% higher chance of not being transferred—and insurance type, with Medicare and Medicaid recipients being less likely to be moved to a higher-level facility.

Hospital characteristics played a crucial role; Level III designation and urban location increased the likelihood of non-transfer significantly. These disparities suggest systemic issues in trauma triage and transfer protocols.

Experts emphasize the importance of integrating Level III centers into broader trauma networks to ensure patients receive the appropriate level of care. Improving state-level guidelines and creating standardized transfer protocols could help address current gaps.

Dr. Marta L. McCrum, a co-author of the study, stressed, "Current trauma systems vary widely across states, and many lack clear guidelines for secondary triage. Strengthening these systems and ensuring all hospitals meet high standards can improve patient outcomes."

Additionally, Dr. Avery B. Nathens highlighted the need for trauma centers to be part of an interconnected system that prioritizes quality care close to patients' homes. While the study offers a comprehensive overview of trauma care patterns nationwide, more research is needed to understand the specific reasons behind transfer decisions.

This study underscores the necessity for systemic improvements in trauma care delivery to ensure that all critically injured patients receive the timely, specialized treatment they need for better recovery chances.

Source: https://medicalxpress.com/news/2025-08-critical-patients-trauma-centers.html