BACKGROUND: It is unclear whether @entity130 @entity1 should be transferred initially to a @entity130 center or local hospital. METHODS: A systematic review and meta-analysis assessed the evidence for direct transport to specialist centers (SCs) versus initial stabilization at non-SCs (NSCs) for major @entity130 or moderate-to-severe @entity542 . Nine databases were searched from 1988 to 2012. Limitations in the study design informed recommendations for future studies. RESULTS: Of 19 major @entity130 studies, five (n = 19,910) included @entity1 not transferred to SCs and adjusted for case mix. Meta-analysis showed no difference in mortality for initial triage to NSCs versus SCs (odds ratio [OR] 1.03; 95% confidence interval [CI], 0.85-1.23). Within studies excluding @entity1 not transferred to SCs, unadjusted analyses of mortality nonsignificantly favored transfer via NSCs (16 studies; n = 37,079; OR, 0.83; 95% CI, 0.68-1.01), whereas adjusted analysis nonsignificantly favored direct triage to SCs (9 studies; n = 34,266; OR, 1.18; 95% CI, 0.96-1.44). Of 11 @entity542 studies, all excluded @entity1 not transferred to SCs and half were in remote locations. There was no significant mortality difference between initial triage to NSCs versus SCs within adjusted analyses (3 studies; n = 1,507; OR, 0.74; 95% CI, 0.31-1.79) or unadjusted analyses (10 studies; n = 3,671; OR, 0.87; 95% CI, 0.62-1.23). CONCLUSION: This systematic review demonstrated no difference in outcomes for direct transport to a @entity130 center versus initial triage to a local hospital. Many studies had significant limitations in the design, and heterogeneity was high. Recommendations for future studies include the following: (i) inclusion of @entity1 not transferred to SCs and those dying during transport; (ii) clear description of centers plus transport distances/times; (iii) adjustments for case mix; and (iv) assessment of morbidity and mortality. LEVEL OF EVIDENCE: Systematic review, level IV.

Impact of prehospital transfer strategies in major @entity130 and XXXX : Systematic review, meta-analysis, and recommendations for study design.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity542 :: ('MESH:D006259', 'Disease') :: ['head injury'] @entity130 :: ('MESH:D014947', 'Disease') :: ['trauma']
@entity542 :: (MESH:D006259,Disease) :: ['head injury']
