Predictors of Interfacility Transfer in Head and Neck Trauma: A National Trauma Data Bank Study

Introduction: Traumatic head and neck (H/N) injuries frequently present to level III/IV trauma centers, yet many require care available only at higher-level facilities. This study aims to characterize transfer patterns in H/N trauma patients initially treated at level III/IV centers. Methods: The National Trauma Data Bank was queried for adults with H/N trauma initially presenting to level III/IV trauma centers between 2007 and 2015. Univariate analysis compared cohort characteristics, while multivariate logistic regression identified independent predictors of transfer. Results: In total, 18,454 patients met inclusion criteria, of whom 5923 (32.1%) were transferred. Cut/piercing and striking injuries were associated with greater transfer odds (aOR: 1.328, 1.653), while motor vehicle trauma was associated with decreased odds (aOR: 0.845, 95% CI: 0.763–0.937). Transfer was associated with jaw dislocation (aOR: 1.871, 95% CI: 1.228–2.852) and H/N burns (aOR: 8.832, 95% CI: 7.131–10.940). Mandibular (aOR: 2.53, 95% CI: 2.19–2.93), skull base (aOR: 1.379, 95% CI 1.229–1.547), and malar/maxillary fractures (aOR: 1.314, 95% CI: 1.163–1.486) increased transfer odds, while nasal bone fracture decreased odds (aOR: 0.817, 95% CI: 0.741–0.901). Isolated H/N injury increased transfer odds (aOR: 1.379, 95% CI: 1.247–1.526). Transferred cohorts most commonly underwent diagnostic imaging and simple bedside procedures prior to transfer. Conclusion: Interfacility transfer is driven primarily by injury patterns rather than physiologic instability, likely reflecting anticipated need for subspecialty surgical intervention. Understanding injury-specific transfer predictors may optimize trauma systems and resource utilization while ensuring timely specialized care.