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Background There is an increasing trend toward regionalization of emergency general surgery, which burdens patients. The absence of a standardized, emergency general surgery transfer algorithm creates the potential for unnecessary transfers. The aim of this study was to evaluate clinical reasoning prompting emergency general surgery transfers and to initiate a discussion for optimal emergency general surgery use. Methods Consecutive emergency general surgery transfers (December 2018 to May 2019) to 2 tertiary centers were prospectively enrolled in an institutional review board–approved protocol. Clinical reasoning prompting transfer was obtained prospectively from the accepting/consulting surgeon. Patient outcomes were used to create an algorithm for emergency general surgery transfer. Results Two hundred emergency general surgery transfers (49% admissions, 51% consults) occurred with a median age of 59 (18 to 100) and body mass index of 30 (15 to 75). Insurance status was 25% private, 45% Medicare, 21% Medicaid, and 9% uninsured. Weekend transfers (Friday to Sunday) occurred in 45%, and 57% occurred overnight (6:00 pm to 6:00 am). Surgeon-to-surgeon communication occurred with 22% of admissions. Pretransfer notification occurred with 10% of consults. Common transfer reasons included no surgical coverage (20%), surgeon discomfort (24%), or hospital limitations (36%). A minority (36%) underwent surgery within 24 hours; 54% did not require surgery during the admission. Median length of stay was 6 (1 to 44) days. Conclusion Conditions prompting emergency general surgery transfers are heterogeneous in this rural state review. There remains an unmet need to standardize emergency general surgery transfer criteria, incorporating patient and hospital factors and surgeon availability. Well-defined requirements for communication with the accepting surgeon may prevent unnecessary transfers and maximize resource allocation.

Therapeutic study, level IV.

To date, no studies have examined the relationship between geographic and socioeconomic factors and the frequency of pedestrians sustaining traumatic injuries from a motor vehicle. The objective of this study was to analyze the impact of location on the frequency of pedestrian injury by motor vehicle. The University of Louisville Trauma Registry was queried for patients who had been struck by a motor vehicle from 2010 to 2015. Demographic and injury information as well as outcome measures were evaluated to identify those impacting risk of pedestrian versus motor vehicle accidents. Number of incidents was correlated with lower median household income. There was also a moderate correlation between the number of incidents and population density. Multivariable analysis demonstrated a significant association between increased median household income and distance from downtown Louisville and decreased risk of death following pedestrian versus motor vehicle accident. Incidence of pedestrian injury by motor vehicles is influenced by regional socioeconomic status. Efforts to decrease the frequency of these events should include further investigation into the mechanisms underpinning this relationship.

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