{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:27:15Z","timestamp":1783384035177,"version":"3.54.6"},"reference-count":18,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare disparities often cause rural BIG 1 TBI patients to be transferred to a higher level of care due to a fear of clinical decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study from 2020 to 2022 that compared patients with the principal diagnosis of BIG1 TBI who were transferred from rural critical access facilities in the upper Midwest to a tertiary care center vs those who were admitted directly to the same tertiary care center. The primary outcomes were cost and mortality. Statistical significance in mortality rates and length of stay was determined using Pearson\u2019s Chi Squared and Kruskal-Wallis tests, with significance thresholds set at \u03b1 = 0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      62 BIG1 patients were examined in the study and 18 were excluded. Of the 44 patients studied, there were no deaths in either group, and length of stay was not significant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .36). Transferred patients also underwent more head CT scans when compared to directly admitted patients (mean 2.5 vs 2.1,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .003). For in-network costs, the average cost of transferred patients was $13,956 and the average cost for direct admissions was $9216 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0003). For out-of-network costs, the average cost of transferred patients was $20,041 and the average cost for direct admission was $13,789 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Compared to patients who are directly admitted, transfer patients have an increased cost of care while having no difference in clinical outcomes. Technological advances in telemedicine and protocolized care may assist with decreasing the cost while increasing efficiency of care for these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251371182","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T18:48:36Z","timestamp":1757011716000},"page":"2028-2034","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical and Financial Impacts of Caring for Mild TBI Patients in the Rural Upper Midwest"],"prefix":"10.1177","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8111-6686","authenticated-orcid":false,"given":"Ryan","family":"Beard","sequence":"first","affiliation":[{"name":"University of North Dakota School of Medicine and Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0199-8825","authenticated-orcid":false,"given":"Nicole D","family":"Lee","sequence":"additional","affiliation":[{"name":"University of North Dakota School of Medicine and Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6400-2384","authenticated-orcid":false,"given":"Khaled","family":"Zreik","sequence":"additional","affiliation":[{"name":"University of North Dakota School of Medicine and Health Sciences"},{"name":"Sanford Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.22605\/RRH7241"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2006.0196"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.06.020"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1047-2797(96)00150-0"},{"key":"e_1_3_4_6_2","volume-title":"Rural America at a Glance","author":"Dobis EA","year":"2021","unstructured":"Dobis EA. Rural America at a Glance. 2021 ed. Washington, DC: USDA; 2021. Published online.","edition":"2021"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000001378"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000317320.79106.7e"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31802d9716"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2020-000483"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000161"},{"key":"e_1_3_4_12_2","unstructured":"Welcome to FAIR health. Accessed March 12 2024.https:\/\/www.fairhealthconsumer.org"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.2763"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.23970\/AHRQEPCCER216"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e3182077efd"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X15589534"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2015.3849"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.09.030"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X20940868"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251371182","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348251371182","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251371182","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:38:21Z","timestamp":1777379901000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348251371182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":18,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1177\/00031348251371182"],"URL":"https:\/\/doi.org\/10.1177\/00031348251371182","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,4]]}}}