The impact of receiving hospitals on the management and outcomes of injured patients in traffic accidents causing mass casualty incidents

Abstract

BACKGROUND: The medical management of mass casualty incidents (MCIs) requires the strategic application of triage methods from the prehospital phase to patient discharge, ensuring the simultaneous and effective treatment of multiple injured individuals. This study aims to examine the transport processes of trauma patients to tertiary hospitals following traffic accidents that result in MCIs, and to evaluate the impact of these processes on patient outcomes. METHODS: This retrospective study investigates the prehospital, inter-hospital transfer, and in-hospital processes of trauma patients injured in traffic accidents causing MCIs over a five-year period within a single province. A comprehensive analysis was conducted from multiple perspectives. A supervised artificial neural network model was employed to predict patient mortality, selected for its ability to identify complex, non-linear patterns in high-dimensional clinical data. RESULTS: A total of 606 patients were included in the study. Of these, 212 (35.0%) underwent secondary transfer to a tertiary hospital, while 394 (65.0%) were directly admitted to a tertiary hospital following traffic accidents causing MCIs. The secondary transfer group experienced longer prehospital times (106.0 vs. 74.7 minutes, p<0.001) and received fewer correct triage decisions (75.0% vs. 92.4%, p<0.001). They also had higher rates of blood transfusion (60.8% vs. 38.8%, p<0.001), vasopressor use (43.9% vs. 22.1%, p<0.001), massive transfusion (36.8% vs. 19.0%, p<0.001), and mechanical ventilation (62.3% vs. 39.8%, p<0.001). In-hospital mortality was higher in the secondary transfer group (20.3%) compared to the direct admission group (8.1%), with an unadjusted odds ratio (OR) of 0.348 (95% confidence interval [CI]: 0.205-0.585, p<0.001). The trained neural network model demonstrated excellent predictive performance for mortality (Training area under the curve [AUC]: 0.947; 95% CI: 0.928-0.966, Testing AUC: 0.841; 95% CI: 0.782-0.899). A stratified analysis examining the impact of correct vs. incorrect triage decisions on mortality revealed that among correctly triaged patients, mortality was significantly higher in the secondary transfer group (22.6%) compared to direct tertiary admission (8.0%), with an OR of 3.38 (95% CI: 1.99-5.78, p<0.001). Overall, patients who underwent secondary transfer had a higher mortality risk compared to direct admissions (OR: 2.35; 95% CI: 1.12-5.10, p=0.0265). A direct comparison between all correctly and incorrectly triaged patients showed that correct triage significantly reduced mortality risk (OR: 4.19; 95% CI: 2.15-8.48, p<0.001). CONCLUSION: In the management of trauma patients following traffic accidents causing MCIs, transferring patients to hospitals that lack adequate trauma care increases mortality. Secondary transport negatively affects hemodynamic stability and leads to a greater need for blood transfusion, vasopressor support, massive transfusion, and mechanical ventilation.