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Invited Critique
December 20, 2010

Time to Transfer May Not Matter, or Does It?Comment on “Analysis of Compliance and Outcomes in a Trauma System With a 2-Hour Transfer Rule”

Author Affiliations

Author Affiliation: R. Adams Cowley Trauma Center, Baltimore, Maryland.

Arch Surg. 2010;145(12):1175-1176. doi:10.1001/archsurg.2010.265

Crandall et al have reviewed the ISTR, concluding that provider-determined transfer time exceeding the state-mandated 2 hours does not worsen outcome. Only 20% of the transfers occurred within 2 hours, but median transfer time was less than 2.5 hours, so half of the patients met the spirit of the regulation.

We have known that injury is a time-related disease since R. Adams Cowley defined the Golden Hour. Patients with traumatic brain injury (TBI) were among the most commonly transferred. Operative therapy for TBI was more common among patients transferred within 2 hours but often did not occur immediately. We get no information about intracranial pressure monitoring, treating intracranial hypertension, or long-term outcomes after TBI. Early transfer and expeditious nonoperative care may be as important as early operation after TBI.

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