Direct transport vs secondary transfer to level I trauma centers in a French exclusive trauma system: Impact on mortality and determinants of triage on road-traffic victims

Autoři: Sophie Rym Hamada aff001;  Nathalie Delhaye aff003;  Samuel Degoul aff004;  Tobias Gauss aff005;  Mathieu Raux aff006;  Marie-Laure Devaud aff007;  Johan Amani aff008;  Fabrice Cook aff009;  Camille Hego aff010;  Jacques Duranteau aff011;  Alexandra Rouquette aff012
Působiště autorů: Université paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France aff001;  CESP, INSERM, Université paris Sud, UVSQ, Université Paris-Saclay, Paris; CESP, INSERM, Maison de Solenn, Paris, France aff002;  Sorbonne Université and Department of Anesthesiology and Critical Care, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France aff003;  Groupe Hospitalier de la Région de Mulhouse et Sud-Alsace, Department of Anesthesiology and Surgical Intensive Care, Mulhouse, France aff004;  Hôpitaux Universitaires Paris Nord Val de Seine, Department of Anesthesiology and Critical Care, AP-HP, Hôpital Beaujon, Clichy, France aff005;  Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d’Anesthésie Réanimation, Paris, France aff006;  SAMU 95, Centre Hospitalier René Dubos, Pontoise, France aff007;  SAMU 78, Centre Hospitalier de Versailles, Le Chesnay, France aff008;  Université Paris Est, Department of Anesthesiology and Critical Care, APHP, Hôpital Henri Mondor, Créteil, France aff009;  Hôpitaux Universitaires Paris Nord Val de Seine, Department of Anesthesiology and Critical Care, AP-HP, Beaujon, Clichy, France aff010;  Université paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France aff011;  Université Paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France aff011;  CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France (Postal address: CESP, INSERM, Maison de Solenn, Paris, France aff012;  Bicêtre Hôpitaux Universitaires Paris Sud, Public Health and Epidemiology Department, APHP, Le Kremlin-Bicêtre, France aff013
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223809



Transporting a severely injured patient directly to a trauma center (TC) is consensually considered optimal. Nevertheless, disagreement persists regarding the association between secondary transfer status and outcome. The aim of the study was to compare adjusted mortality between road traffic trauma patients directly or secondarily transported to a level 1 trauma center (TC) in an exclusive French trauma system with a physician staffed prehospital emergency medical system (EMS).


A retrospective cohort study was performed using 2015–2017 data from a regional trauma registry (Traumabase®), an administrative database on road-traffic accidents and prehospital-EMS records.

Multivariate logistic regression models were computed to determine the role of the modality of admission on mortality and to identify factors associated with secondary transfer. The primary outcome was day-30 mortality.

Results: During the study period, 121.955 victims of road-traffic accident were recorded among which 4412 trauma patients were admitted in the level 1 regional TCs, 4031 directly and 381 secondarily transferred from lower levels facilities. No significant association between all-cause 30-day mortality and the type of transport was observed (Odds ratio 0.80, 95% confidence interval (CI) [0.3–1.9]) when adjusted for potential confounders. Patients secondarily transferred were older, with low-energy mechanism and presented higher head and abdominal injury scores. Among all 947 death, 43 (4.5%) occurred in lower-level facilities. The population-based undertriage leading to death was 0.15%, 95%CI [0.12–0.19].


In an exclusive trauma system with physician staffed prehospital care, road-traffic victims secondarily transferred to a TC do not have an increased mortality when compared to directly transported patients.

Klíčová slova:

Antiplatelet therapy – France – Head injury – Intensive care units – Physicians – Roads – Traumatic injury


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