Interfacility Transfers for Isolated Craniomaxillofacial Trauma: Perspectives of the Facial Trauma Surgeon

Abstract

Study design: Secondary overtriage is a burden to the medical system. Unnecessary transfers overload trauma centers, occupy emergency transfer resources, and delay definitive patient care. Craniomaxillofacial (CMF) trauma, especially in isolation, is a frequent culprit.

Objective: The aim of this study is to assess the perspectives of facial trauma surgeons regarding the interfacility transfer of patients with isolated CMF trauma.

Methods: A 31-item survey was developed using Likert-type scale and open-ended response systems. Internal consistency testing among facial trauma surgeons yielded a Cronbach's α calculation of .75. The survey was distributed anonymously to the American Society of Maxillofacial Surgeons, the North American Division of AO Craniomaxillofacial, and the American Academy of Facial Plastic and Reconstructive Surgery. Statistical significance in response plurality was determined by nonoverlapping 99.9% confidence intervals (P < .001). Sum totals were reported as means with standard deviations and z scores with P values of less than .05 considered significant.

Results: The survey yielded 196 responses. Seventy-seven percent of respondents did not believe that most isolated CMF transfers required emergency surgery and roughly half (49%) thought that most emergency transfers were unnecessary. Fifty-four percent of respondents agreed that most patients transferred could have been referred for outpatient management and 87% thought that transfer guidelines could help decrease unnecessary transfers. Twenty-seven percent of respondents had no pre-transfer communication with the referring facility. Perspectives on the transfer of specific fracture patterns and their presentations were also collected.

Conclusion: Most facial trauma surgeons in this study believe that emergent transfer for isolated CMF trauma is frequently unnecessary. Such injuries rarely require emergent surgery and can frequently be managed in the outpatient setting without activating emergency transfer services. The fracture-specific data collected are a representation of the national, multidisciplinary opinion of facial trauma surgeons and correlate with previously published data on which specific types of facial fractures are most often transferred unnecessarily. The results of this study can serve as the foundation for interfacility transfer guidelines, which may provide a valuable resource in triaging transfers and decreasing associated health-care costs.

Keywords: facial; fracture; interfacility; isolated; secondary overtriage; transfer; unnecessary.

Figure 1.

Graph depicting responses to the statement “transfers require emergency surgery.” *Statistically significant (P < .01) plurality of responses by nonoverlapping 99.9% confidence intervals.

Figure 2.

Graph depicting responses to the statement “emergency transfers are necessary.” *Statistically significant (P < .01) plurality of responses by nonoverlapping 99.9% confidence intervals.

Figure 3.

Graph depicting responses to the statement “patients could have been referred for outpatient management.” *Statistically significant (P < .01) plurality of responses by nonoverlapping 99.9% confidence intervals.

Figure 4.

Graph depicting responses to the statement “transfer guidelines would help decrease unnecessary transfers.” *Statistically significant (P < .01) plurality of responses by nonoverlapping 99.9% confidence intervals.