Evaluating Appropriateness of Interfacility Transfers for Patients with Facial Trauma Including Acute Orbital Floor Fractures

Abstract

Background:

Patients with orbital floor fractures are frequently transferred between facilities for suspected clinical need, although many of these transfers may be unnecessary.

Objective:

To compare the characteristics among patients with facial trauma and orbital floor fracture between those presenting directly compared to those transferred from an outside facility.

Methods:

Patients presenting to a single level 1 emergency department with facial trauma, including acute orbital floor fracture, were reviewed. Transfers were recorded as concordant if it resulted in additional clinical benefit. Data collection included surgery rates, age, insurance status, and area deprivation indices, which measure neighborhood-level socioeconomic disadvantage. Analysis included chi-square testing and logistic regression.

Results:

Among 1335 patients (69% male, median age: 46 years [interquartile range: 31–63], 318 were transferred with a documented reason. Of the transfers, 45.9% (n = 146) were deemed concordant. Transferred patients were significantly older than primary presenters (53.5 [34.2–70.8] vs. 45.0 [31.0–61.0], p < 0.01). Surgery rates were similar among transfers and primary presenters (20.8% vs. 20.3%, p = 0.692). Transferred patients had significantly higher levels of national and state socioeconomic deprivation (p < 0.01).

Conclusion:

Nearly half of all interfacility transfers for facial trauma, including acute orbital floor fractures, did not result in additional intervention or a change in management, highlighting the need to identify opportunities for improvement.