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Unnecessary Transfer of Facial Fractures2025
Type: New Practice Management Guideline (PMG)
Category: Trauma
Committee Liaison: Rachel D. Appelbaum, MD
Team leader(s)
Statement of Need:
Several studies consistently report that over half of patients with facial fractures who are transferred to a trauma center do not undergo operative intervention during that hospitalization. This raises a question concerning the necessity of transfer. Unnecessary transfer burdens the patient and their family and also places unnecessary strain on the prehospital system, the trauma center, and the specialist providers involved. The overall hospital cost of facial fractures transfers in the US is nearly $100 million annually. The burden for patients and their families can be particularly complex, incorporating significant cost, time, loss of work, and the psychological burden of unnecessary medical bills and transfers in a country where over half of bankruptcies are due to medical expenses. Current care patterns vary widely and may involve transfer of any patients with facial fractures to a trauma center given the lack of trauma or craniofacial specialists at most referring hospitals. Further, typically, requests for transfer are received by a trauma surgeon, who may not have craniofacial trauma expertise, thus prompting their acceptance of the patient to the trauma center to ensure the patient receives immediate, in-person care from a craniofacial specialist, which may not actually be necessary urgently. There are no evidence-based guidelines indicating which patients may safely avoid transfer to a trauma center and seek outpatient follow up with a craniofacial specialist. This PMG seeks to develop multidisciplinary evidence-based guidelines to delineate which patients may safely be referred for outpatient follow up with a craniofacial specialist rather than transferred to a trauma center for inpatient consultation.
Team Members:
Lisa Kodadek, MD FACS (Senior Team Leader)
Asanthi Ratnaskera, DO, FACS
James Bardes, MD
Khaled Zreik, MD, MS, FACS
Rachel Appelbaum, MD
SaeRam Oh Meehan, BS, MS, MD
Conley Coleman, DO
Eric Legome (Emergency Medicine)
Jarone Lee (Emergency Medicine)
Jeff Hajibandeh (OMFS)
John Nguyen (Ophthalmology)
Brian Kellermeyer (ENT)