{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T05:47:28Z","timestamp":1771652848912,"version":"3.50.1"},"reference-count":27,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T00:00:00Z","timestamp":1623801600000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2021,4,18]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Trauma systems in rural areas often require longdistance transfers for definitive care. Delays in care, such as delayed femurfracture repair have been reported to be associated with poorer outcomes, butlittle is known about how transfer time affects time to repair or outcomesafter femur fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective review of all trauma patients transferred to our level 1 rural trauma center between May 1, 2016-April 30, 2019. Patient demographics and outcomes were abstracted from chart and trauma registry review. All patients with femur fractures were identified. Transfer time was defined as the time from admission at the initial hospital to admission at the trauma center, and time to repair was defined as time from admission to the trauma center until operative start time. Our outcome variables were mortality, in-hospital complications, and hospital length of stay (LOS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over the study period1,887 patients were transferred to our level 1 trauma center and 398 had afemur fracture. Compared to the entire transfer cohort, femur fracture patientswere older (71 versus 57 years), and more likely to be female (62% versus 43%).The majority (74%) of patients underwent fracture repair within 24hours. Delay in fracture fixation &gt;24\u2009hours wasassociated with increased length of stay (5 days versus 4\u2009days; p&lt;0.001),higher complication rates (23% versus 12%; p=0.01), and decreased dischargehome (19% vs. 32%, pp=0.02), but was not associated with mortality (6% versus5%; p=0.75). Transfer time and time at the initial hospital were not associatedwith mortality, complication rate, or time to femur fixation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Fixation delay greater than 24\u2009hours associated with increased likelihood of in-hospital complications, longer length of stay, and decreased likelihood of dischargehome. Transfer time not related to patient outcomes or time to femur fixation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III; therapeutic\/care management.<\/jats:p><\/jats:sec>","DOI":"10.1136\/tsaco-2021-000701","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T15:21:10Z","timestamp":1623943270000},"page":"e000701","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Is it a matter of time? The effect of transfer time on femur fracture outcomes"],"prefix":"10.1136","volume":"6","author":[{"given":"Leah E","family":"Larson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa L","family":"Harry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul K","family":"Kosmatka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9406-3114","authenticated-orcid":false,"given":"Kristin P","family":"Colling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"2024051311521965000_6.1.e000701.1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1001\/jamaneurol.2014.3188","article-title":"Effects of golden hour thrombolysis: a prehospital acute neurological treatment and optimization of medical care in stroke (PHANTOM-S) substudy","volume":"72","author":"Ebinger","year":"2015","journal-title":"JAMA Neurol"},{"key":"2024051311521965000_6.1.e000701.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.07.002"},{"key":"2024051311521965000_6.1.e000701.3","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199910000-00038"},{"key":"2024051311521965000_6.1.e000701.4","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1016\/j.surg.2016.06.020","article-title":"Rural risk: geographic disparities in trauma mortality","volume":"160","author":"Jarman","year":"2016","journal-title":"Surgery"},{"key":"2024051311521965000_6.1.e000701.5","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1097\/TA.0000000000001883","article-title":"Mapping areas with concentrated risk of trauma mortality: a first step toward mitigating geographic and socioeconomic disparities in trauma","volume":"85","author":"Jarman","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2024051311521965000_6.1.e000701.6","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/000313481708300123","article-title":"The effect of interhospital transfers on the outcome of rural trauma","volume":"83","author":"Wild","year":"2017","journal-title":"Am Surg"},{"key":"2024051311521965000_6.1.e000701.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2010.00918.x"},{"key":"2024051311521965000_6.1.e000701.8","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1097\/BOT.0000000000001306","article-title":"Delay in hip fracture surgery prolongs postoperative Hospital length of stay but does not adversely affect outcomes at 30 days","volume":"32","author":"Mitchell","year":"2018","journal-title":"J Orthop Trauma"},{"key":"2024051311521965000_6.1.e000701.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.17606"},{"key":"2024051311521965000_6.1.e000701.10","unstructured":"American College of Surgeons, Committee on Trauma . 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