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Objectives There is a perception, with mixed literary support, that patients are transferred from community hospitals to tertiary medical centers for non-clinical reasons (ie, payor, race, and admission time). Over-triage risks unequally burdening the tertiary medical centers within a trauma system. This study aims to identify potential non-clinical factors associated with the transfer of injured patients. Methods Using the 2018 North Carolina State Inpatient Database, patients with a primary diagnosis of spine, rib or extremity fractures, or TBI were identified using ICD-10-CM code and admission type of “Urgent,” “Emergency,” or “Trauma.” Patients were divided into cohorts of “retained” (at community hospital) or “transferred” (Level-1 or 2 trauma centers). Results 11,095 patients met inclusion criteria; 2432 (21.9%) patients made up the transfer cohort. The mean ISS for all retained patients was 2.2 (±.9) and 2.9 (±1.4) for all transferred patients. The transfer cohort was younger (mean age 66 v 75.8), underinsured, and more likely to be admitted after 1700 ( P < .001). Similar differences were seen regardless of injury pattern. Conclusions Patients transferred to trauma centers were more likely to be underinsured and be admitted outside of normal business hours. These transferred patients had longer lengths of stay and higher mortality rates. Across all cohorts, similar ISS suggests that a portion of the transfers could be managed at a community hospital. After hours transfers suggest a need for more robust community hospital coverage. Intentional triage of the injured patient encourages appropriate utilization of resources and is crucial to maintaining high-functioning trauma centers and systems.

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associated with discontinuation of oral medication. Risk adjusted complication rates were significantly higher after gastric bypass than sleeve gastrectomy, regardless of whether the patient was taking oral diabetic medications only or was also on insulin (11.2% vs 4.8%, p<0.0001 and 12.0% vs 7.4%, p<0.0001, respectively).CONCLUSION: Patients requiring insulin experience higher rates insulin discontinuation after gastric bypass but also have significantly higher complication rates, when compared to sleeve gastrectomy. However, if patients are on oral diabetic medication alone, rates of medication discontinuation are over 85%, regardless of procedure type. Disease severity is an important factor when deciding on the optimal procedure for diabetes.