This retrospective cohort study examined whether no-fault automotive insurance states (FL, NY) had lower rates of re-triage (same-day inter-hospital transfer to a high-level trauma center) among severely injured Medicare MVC patients (ISS >15) compared to at-fault states (MD, WI), using 2016–2021 HCUP data across 345 hospitals.
Re-triage rates were 2.3% in no-fault vs. 8.1% in at-fault states (p<0.001). No-fault states had 0.31 adjusted odds of re-triage (95% CI: 0.17–0.56) for severe MVC patients. At-fault state MVC patients had 1.77 higher adjusted odds of re-triage vs. fall patients in at-fault states (95% CI: 1.23–2.54).
- Only 4 states studied, limiting generalizability across all U.S. no-fault/at-fault jurisdictions. - Study population restricted to Medicare patients (median age 70), so findings may not apply to younger adults or other payers. - Retrospective observational design cannot establish causality between insurance laws and re-triage decisions.
Clinicians and hospital administrators should recognize that automotive insurance payment laws may influence inter-hospital transfer patterns for severe MVC patients — an effect not seen with fall patients. Trauma systems in at-fault states may benefit from reviewing financial barriers that could be driving re-triage decisions.
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