Study Examines Evaluation of Severely Injured at Non-Trauma Centers

Main Points:

Severely injured patients who first are evaluated at non-trauma emergency departments (EDs) are less likely to be transferred to trauma centers if they are insured, according to a study by M. Kit Delgado, M.D., M.S., of the University of Pennsylvania, Philadelphia, and colleagues.

Published in:

JAMA Surgery

Study Further:

Trauma is the leading cause of premature death before age 65 in the United States. Timely care in a designated trauma center has been shown to reduce death rates by 25 percent, according to the study background.

The authors analyzed a nationwide sample of emergency room trauma patients (ages 18 to 64) who were seen at 636 non-trauma centers and they assessed factors associated with inpatient admission vs. transfer to a trauma center.

In the study, 54.5 percent of the patients seen at the non-trauma centers were admitted. Compared to patients without insurance, the risk of admission vs. transfer was an absolute 14.3 percent higher for patients with Medicaid and 11.2 percent higher for patients with private insurance.

“In summary, we found that insured, critically injured trauma patients are much less likely to be transferred out of non-trauma EDs [emergency departments] than uninsured trauma patients after adjusting for patient, injury and hospital characteristics. Given that transfer to a trauma center has been shown to reduce mortality, these insured patients may be receiving suboptimal care,” the study concludes.


M. Kit Delgado MD, MS, Michael A. Yokell ScB, Kristan L. Staudenmayer MD, MS, David A. Spain MD, Tina Hernandez-Boussard PhD, MPH, N. Ewen Wang MD (2014). Factors Associated With the Disposition of Severely Injured Patients Initially Seen at Non–Trauma Center Emergency Departments: Disparities by Insurance Status JAMA Surgery DOI: 10.1001/jamasurg.2013.4398

(JAMA Surgery. Published online February 19, 2014. doi:10.1001/jamasurg.2013.4398)

Editor’s Note:

This study was supported by a grant from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory:

To contact author M. Kit Delgado, M.D., M.S., call Jessica Mikulski at 215-349-8369 or email

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