Written by Kathryn Sulkowski and Ketan Patel
Spoon Feed
Over half of transferred patients with facial fractures don’t need treatment or admission. This new facial injury algorithm may help.
Face it, you didn’t need that ambulance ride
Patients with facial trauma are often transferred to higher-level trauma centers due to limited specialist availability. Despite evidence that many can be discharged without procedures, the lack of standardized guidelines leads to inconsistent transfer decisions, and establishing clear protocols is essential for improving patient care. This study aimed to determine which patients with isolated craniomaxillofacial trauma require transfer to a higher level of care.
A retrospective review was conducted over five years (2017–2021) at a Level I trauma center, evaluating 511 adult patients transferred with isolated facial injuries. Transfers were classified as appropriate or potentially inappropriate based on predefined criteria and expert panel consensus. Of 511 transfers, 252 (49%) were appropriate, requiring admission, urgent/emergent intervention, or observation. However, 259 (51%) were potentially unnecessary. Among appropriate transfers, 79% received urgent surgery and 15.5% underwent emergency procedures. Inappropriate transfers typically resulted in ED discharge (81%) without intervention, with only 5.1% later requiring outpatient procedures. This study presents some notable limitations. Cosmetic-only transfers were explicitly excluded, and patients who needed a transfer but did not ultimately receive one were not included in the data collection. Furthermore, the study did not examine the long-term effects of the guidelines on patient outcomes, which could provide valuable insights into their overall impact.
They propose this smart, evidence-based Facial Injury Guidelines, or FIG algorithm – to help healthcare systems save money, time, and beds (and maybe a few ambulance rides), though it needs validation.
How does this change my practice?
As a practitioner at both a Level 1 trauma center that treats patients with facial fractures and a freestanding emergency department that may refer these patients, I believe a unified set of guidelines for transferring individuals with facial fractures would be beneficial. This would help ensure that patients receive the appropriate level of care while preventing the overuse of resources at trauma centers.
Source
Look me in the face and tell me that I needed to be transferred: Defining the criteria for transferring patients with isolated facial injuries. J Trauma Acute Care Surg. 2025 May 9. doi: 10.1097/TA.0000000000004651. Epub ahead of print. PMID: 40341445
