C LIN IC A L NE WS
Futile Trauma Transfers Uncommon but Costly By JENNA BASSETT, PhD
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espite making up less than 2% of trauma transfers, unsalvageable patients present a significant cost burden to the health care system, researchers report.
Researchers at the University of Kansas Medical Center (KUMC) investigated the rates and costs of futile transfers within their organization between June 2017 and June 2019. Futility was defined as a patient who had a stay that was no more than 48 hours that resulted in death, implementation of hospice care or discharge with no major operative, endoscopic or radiological intervention. Within the study period, there were 1,241 trauma transfers. Among the 407 trauma transfers with hospitalization time less than 48 hours, 18 patients (1.5% of the study population) were deemed futile. In both the futile and nonfutile groups, the majority of patients were transferred for traumatic brain injury and the need for neurosurgical consultation or intervention. The researchers evaluated injury severity among transferred
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are doing. They can share knowledge to improve quality of care, Dr. Lal said. It also helps answer questions from families concerning patients who present with an acute COVID-19 infection about expected outcomes, based on the organ support required, he said. 18
OR Management News • June 2021
patients using the Injury Severity Score (ISS), a validated score that correlates with morbidity, mortality and hospitalization time after trauma. Scores above 15 indicate severe injury. Futile transfers were older, with more severe injuries as indicated by a median ISS of 21 versus 8 in nonfutile patients. Specifically, futile patients had more severe injuries to the head and torso. The median cost of treating futile patients was $56,396, and the total cost to the health care system exceeded $1.7 million during the two-year study period. The authors estimated that elimination of futile transfers would result in a cost savings of over $27 million annually in the United States. “Our study clearly has limitations in that our data represents the retrospective experience of a single institution serving a large network of rural referral facilities,” explained presenting author Craig Follette, DO, a general surgery resident at KUMC, in Kansas City. “The data may not be able to be generalized to other trauma networks but could be compared to similar regional networks.” Dr. Follette also added that the study definition of futile was conservative, which may affect study conclusions, and the data do not show the intricacies of what occurs in the period surrounding a trauma transfer. “It is possible that patients received therapies not available at referral centers, although, in our experience, this would be extremely unlikely in the absence of ongoing consultant care.” To optimize trauma transfer, the researchers propose a new trauma transfer paradigm that incorporates a telehealth support component that could be used to extend specialist support to critical access hospitals. “While beyond the scope of this paper, we believe that this future state will involve enhanced means of communication through telehealth/tele-trauma, and the overall sharing of Level I trauma center expertise beyond the walls of the center itself,” Dr. Follette said. “I believe the next step is collaboration with other centers in multicenter studies to truly define this special patient population and guide further resource utilization region by region.” The authors concluded that additional work is needed to avoid futile care and ensure appropriate allocation of health care resources to patients who will benefit. ■
“Our findings provide novel prognostic estimates for important patient-centered outcomes of survival and probability of discharge home across a wide range of ages and types of organ supportive therapies commonly required for patients with severe COVID-19,” he said. To date, of the nearly 48,000 patients included in the registry, 28% received IMV, while 13% and 2%, respectively,
had noninvasive ventilation and ECMO. One in five received highflow nasal oxygen and 10% were placed on dialysis. The median length of time that patients receive IMV is nine days; ICU stays last a median of seven days. Just over half (56%) of patients are discharged alive. The real-time dashboard of the VIRUS registry is available at sccmcovid19.org. ■
