Preventable transfers in pediatric trauma: A 10-year experience at a level I pediatric trauma center

Area of Science:

• Pediatric Trauma Care
• Healthcare Systems Analysis
• Injury Prevention

Background:

• Children with traumatic injuries often require transfer between facilities for specialized pediatric trauma care.
• Evaluating the necessity of these transfers is crucial for optimizing patient outcomes and resource allocation.
• Freestanding level-I pediatric trauma centers receive a substantial volume of interfacility transfers.

Purpose of the Study:

• To identify and characterize potentially preventable transfers (PT) to a freestanding level-I pediatric trauma center.
• To analyze the characteristics of children whose transfers were deemed preventable.
• To provide data for improving the efficiency and effectiveness of pediatric trauma care networks.

Main Methods:

• Retrospective analysis of children with traumatic injuries transferred between 2003 and 2013.
• Definition of a potentially preventable transfer: discharge within 36 hours without surgery or advanced imaging.
• Comparison of demographic, injury, and treatment characteristics between preventable and non-preventable transfers.

Main Results:

• 6380 children were transferred; 27% were classified as potentially preventable transfers (PT).
• PTs were younger, had lower injury severity scores (ISS), shorter lengths of stay (LOS), and fewer pediatric intensive care unit (PICU) admissions compared to non-PTs.
• Head injury was the most common diagnosis; 61% received CT imaging before transfer, and 29% were discharged from the emergency department.

Conclusions:

• A significant proportion of interfacility pediatric trauma transfers can be classified as preventable.
• Reducing preventable transfers presents an opportunity to enhance the value and efficiency of pediatric trauma care.
• Further research can inform strategies to minimize unnecessary transfers and improve patient care pathways.