Unnecessary Interfacility Transfers for Craniomaxillofacial Trauma.

Background: Patients with craniomaxillofacial injuries are frequently transferred for specialist evaluation. Although transfer guidelines have improved outcomes for trauma care, no standards exist for craniomaxillofacial injuries. As a result, many patients are unnecessarily transferred emergently between facilities, resulting in high costs to patients and the health care system. This study assesses the regional frequency and necessity of transfers for isolated craniomaxillofacial injury.

Methods: A retrospective review was conducted of all transfers with a diagnosis of "facial trauma" from 2013 to 2018. Using a previously validated framework, emergency interfacility transfers were deemed either necessary or unnecessary.

Results: A total of 368 transfers were identified with isolated craniomaxillofacial injuries. Only 27 percent of transfers required admission. Half of transfers were unnecessary, none of which required intervention by the facial trauma service. Of 49.5 percent of necessary transfers, 38 percent required admission for surgery or management of symptoms related to facial injury, 62 percent were discharged from the emergency department, and three patients required emergency surgery.

Conclusions: Isolated craniomaxillofacial trauma rarely requires emergency surgery; however, transferred patients occasionally require urgent and elective procedures. Unnecessary transfers result in substantial expense to the patient and the health care system, and patients ultimately experience a delay in definitive care. Unnecessary patient evaluation diverts emergency staff and resources, increasing wait times and morbidity for other patients. This study demonstrates an opportunity for transfer guidelines to improve interfacility triage of patients with facial injury. Clinical question/level of evidence: Therapeutic, IV.