Estimating the National Burden of Potentially Avoidable Interfacility Transfer Among Patients with Isolated Facial Injury in the US.

Abstract

Interfacility transfers for facial trauma are common but often avoidable. However, the magnitude of these potentially avoidable interfacility transfers (PAITs), which can strain trauma systems and incur avoidable costs to the patients, remains unknown. This study aimed to quantify the burden of PAITs for isolated facial trauma in the US. A retrospective analysis using the 2022 Nationwide Emergency Department Sample was performed. Patients aged 16 years and older with isolated facial injuries were identified using ICD-10-CM codes and the Abbreviated Injury Scale. A multiple logistic regression model was developed from level I trauma center (TC) data to predict emergency department home discharge, internally validated, and applied to transfers from level III or non-TCs to identify PAITs based on high predicted discharge probabilities. Among 856,197 patients with isolated facial trauma, 661,149 were initially treated at level III or non-TCs, of whom 2.4% were transferred to higher-level facilities. Using a Youden Index-derived predicted home discharge probability of greater than or equal to 0.946, 43.2% (95% CI 40.9% to 45.4%) of these transfers were classified as potentially avoidable. These transfers were more common among younger, male individuals, White race, those with private insurance, urban residence and those injured by being struck, treated in Southern hospitals, or private not-for-profit facilities. A substantial proportion of interfacility transfers for isolated facial trauma may be avoidable when benchmarked against discharge practices at level I TCs. These findings highlight a critical opportunity to optimize secondary triage decision-making, possibly in conjunction with telehealth consultations, before patient transfer.