(HealthDay News) — For patients with severe injuries initially evaluated at a non-trauma center emergency department, admission versus transfer to a trauma center is more likely for patients with Medicaid or private insurance, compared with no insurance, according to a study published online February 19 in JAMA Surgery.

M. Kit Delgado, MD, from the University of Pennsylvania in Philadelphia, and colleagues conducted a retrospective analysis of the 2009 Nationwide Emergency Department Sample. The authors sought to determine patient- and hospital-level factors associated with the decision to admit rather than transfer severely injured patients from non-trauma center emergency departments to trauma centers.

The researchers identified 4,513 observations from 636 non-trauma center emergency departments in 2009, representing a nationally weighted population of 19,312 non-trauma center emergency department encounters for major trauma. In 2009, 54.5% were admitted to the non-trauma center. The adjusted absolute risk of admission vs. transfer was 14.3% higher for patients with Medicaid and 11.2% higher for patients with private insurance, compared with patients without insurance. Severe abdominal injuries, urban teaching hospital versus non-teaching hospital, and annual emergency department visit volume were also associated with admission versus transfer.

“Given that transfer to a trauma center has been shown to reduce mortality, these insured patients may be receiving suboptimal care,” the authors write.

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