when the severely injured patients whom weresent to the lower levels of trauma carefacilities due to long distance fortransportation to TC or the unstable conditionsthat made the long distant transportation to TCfatal.Transfer itself can increase the injuredpatients risk of adverse outcome.As an independent variable, transfer patientswere proved to have an overall mortality higherthan those admitted directly(25016 vs 21％) in anon-randomized study.Esposito TJ, Crandall M, Reed RL, et al.Socioeconomic factors, medicolegal issues, andtrauma patient transfer trends: is there aconnection? J Trauma. 2006;61 : 1380 - 1386;discussion 1386 - 1388.Goldfarb CA, Borrelli J Jr, Lu M, et al. Aprospective evaluation of patient s with isolatedorthopedic injuries transferred to a Level Onetrauma center. J Orthop Trauma. 2006; 20 : 613 -617.