Defense Date


Document Type


Degree Name

Master of Science



First Advisor

Adam Sima

Second Advisor

Le Kang

Third Advisor

Stefan Leichtle


Transferring patients with traumatic brain injury (TBI) to trauma level I hospital from other lower level hospitals has been shown to increase the mortality compared to when patients are directly transported to trauma centers. Despite the results from studies and the field triage recommendation of transporting the TBI patients to trauma center, nearly half of the TBI cases are transported to other hospitals before transferring to the trauma center. A retrospective analysis of patients with TBI in the state of Virginia was carried out to access if direct transport of patients with TBI to trauma center improves the outcome compare to the inter-facility transfer patients. Patients were categorized into two groups; direct transport and inter-facility transfers. Hospital discharge disposition was considered as the measure of outcome. A proportional odds cumulative logistic regression was utilized on propensity score matched patients and on unmatched patients. Of the 2,695 patients included, 74.9% of the patients were in the direct transport group and 25.1% in the inter-facility transfer group. Propensity score matching was able to match 79.6% of the patient included in the study. Before matching, unadjusted odds ratio was not significant for inter-facility transfers patients and direct transport patients (OR =1.12, P = 0.239). However, adjusted odds ratio was found to be significant (OR=0.63, P < 0.001) with direct transport group as reference group. After matching, both adjusted and unadjusted odds ratio showed that the inter-facility transfer were likely to have better outcome compared to direct transport. Based on the finding, transporting TBI patients to hospitals other than trauma level I subsequently transferring to trauma level I is better both for the patients and the emergency medical service (EMS) agencies as they reduce the travel time by not directly transporting patients to trauma level I hospitals.


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