Predictors of Hospital Transfer for Patients Presenting with Penile Fractures in Emergency Departments in the United States
Dayron Rodriguez, MD, MPH1; Kai Li, MD2; Michel Apoj, BS1; Archana Rajender, MD1; Nannan Thirumavalavan, MD3; Ricardo Munarriz, MD1.
1Boston Medical Center, Boston University School of Medicine, Boston, MA; 2Massachusetts General Hospital, Boston, MA; 3Baylor College of Medicine, Houston, TX
BACKGROUND: Penile fracture (PF) is a medical emergency that requires prompt surgical management. There is currently no study in the literature that assesses the characteristics of those patients with PF presenting to the emergency room that are transferred to another hospital for further care. In this study, we examine the patient and ED attributes associated with an increased likelihood of being transferred to another institution for further management.
METHODS: ED visits with a primary diagnosis of PF between 2010 and 2014 were abstracted from the Nationwide Emergency Department Sample (NEDS) (Healthcare Cost and Utilization Project, the U.S. most comprehensive source of hospital care data). Univariable and multivariable analyses were performed of patient and hospital characteristics of those patients transferred with PF.
RESULTS: Between 2010 and 2014 we identified a weighted estimate of 8,135 visits to the emergency department for PF in the US. Although, the majority of the patients were treated in the presenting hospital (87.4 %), 10.4% (an estimated 848 visits) resulted in a patient transfers to other institutions. Approximately 36.9% of patients presented initially to a non-teaching / non-trauma hospital and 8.05% had an associated urethral injury. On multivariable analyses independent predictors of transfer to another institution included type of insurance (Medicaid vs Private OR 1.70, p < 0.001), hospital location (rural vs urban teaching hospital OR 5.91, p <0.001), ZIP code income (very low vs. very high OR 2.68, p < 0.001), emergency department volume (very low vs very high OR 1.84, p < 0.006), level of trauma center (Level 1 & 2 vs. Level 3 & non-trauma OR 5.32, P <0.001), country region (Northeast/South vs. West/Midwest (OR 1.56, p <0.038), and day of the week (weekend vs. weekday) (OR 1.54, p <0.001).
CONCLUSIONS:
To our knowledge, this study is the first to investigate the predictors of hospital transfer for patients presenting with PF to the ER in the US. Approximately 10 percent of patients are transferred to other institutions for further care. Predictors of transfer to another hospital included type of insurance, hospital location/teaching status, ZIP code income, emergency department volume, level of trauma center, country region, and day of the week.
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