Look me in the face and tell me that i needed to be transferred: Defining the criteria for transferring patients with isolated facial injuries

OBJECTIVES Despite the known burden of inappropriate overtriage of patients with facial injuries on the health care system, no comprehensive guidelines for the transfer of these patients exist. The aim of this study was to define guidelines regarding which patients with isolated craniomaxillofacial trauma require transfer to higher levels of care. METHODS We performed a 5-year review at a Level I trauma center (2017-2021). We included all transferred patients with isolated facial fractures. Patients were stratified into appropriate (those who received any emergency [taken directly to operating room] or urgent intervention [intervention in same admission] for facial injuries or were admitted to the ward for observation) and potentially inappropriate (patients who did not require any emergent or urgent intervention or admission to the facial trauma service [FTS]) transfers. Three independent experts reviewed the reason for the transfer and required interventions during the hospitalization and defined if the transfer was appropriate. RESULTS We identified 511 patients transferred to our Level I trauma center with isolated facial injuries. Over half (n = 259, 51%) of these transfers were potentially unnecessary, as these patients did not require intervention or admission. Overall, FTS was consulted for 89% of patients. A total of 252 patients (49%) were identified as appropriate transfers, of which 54% were admitted to the floor, 15% received emergency intervention, and 79% underwent urgent intervention. Eighty-two percent of potentially inappropriate transfers received an FTS consultation, and 81% were discharged from ED with a median length of stay of 6 hours. After a review of patient's hospitalization events, the Facial Injury Guidelines were defined. CONCLUSION More than half of the patients with isolated facial fractures did not require any intervention or admission. The proposed guidelines could significantly reduce unnecessary transfers and health care costs for patients with isolated craniomaxillofacial trauma. Prospective validation of the Facial Injury Guidelines is warranted before it could be considered for implementation. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.