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Transfer and nontransfer patients in isolated low-grade blunt pediatric solid organ injury: Implications for
Robert A Tessler1, Vivian H Lyons, Judith C Hagedorn
1From the Department of Surgery (R.A.T.), UCSF East Bay, Oakland, California; Harborview Injury Prevention and Research Center (R.A.T., V.H.L., J.C.H., M.S.V., S.A., F.P.R); Department of Surgery (R.A.T., A.G., S.A.), Department of Epidemiology (V.H.L., F.P.R.), Department of Urology (J.C.H.), Department of Anesthesiology and Pain Medicine (M.S.V.), University of Washington; Division of Pediatric General and Thoracic Surgery (A.G.), Seattle Children's Hospital; Department of Surgery, Division of Trauma, Burns, and Critical Care (S.A.), and Department of Pediatrics (F.P.R.), University of Washington, Seattle, Washington.
Insights
Pediatric patients with isolated low-grade blunt solid organ injuries often do not require surgery and may not need transfer to a higher level trauma center. Revising transfer policies can prevent unnecessary transfers and reduce costs in pediatric trauma care.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Public Health
Background:
- Regionalization of trauma care is a national priority.
- Hospitalization for blunt abdominal trauma is common in children, often involving transfers.
- Understanding care variations for pediatric blunt abdominal trauma is crucial.
Purpose of the Study:
- To compare outcomes for pediatric patients with blunt abdominal trauma based on transfer status and trauma center level.
- To determine differences in mortality, treatment, and length of stay.
- To inform trauma system policies regarding patient transfers.
Main Methods:
- Retrospective cohort study using the Washington state trauma registry (2000-2014).
- Included patients 16 years or younger with isolated Grade I-III spleen, liver, or kidney injury.
- Compared outcomes for patients treated at lower-level trauma centers versus those transferred to higher-level centers.
Main Results:
- Of 1177 pediatric patients with low-grade solid organ injuries, 226 went to higher-level centers, 600 stayed at lower-level centers, and 351 were transferred.
- No significant difference in surgery risk between transferred and non-transferred patients initially at lower-level centers.
- Non-transferred patients had a significantly shorter hospital stay compared to transferred patients.
- One death occurred among all patients.
Conclusions:
- Pediatric patients with isolated low-grade blunt solid organ injuries rarely require intervention and may not need transfer.
- Trauma systems should re-evaluate and revise transfer policies for these patients.
- Reducing unnecessary transfers offers potential cost savings in pediatric trauma care.
Background:
Regionalization of trauma care is a national priority and hospitalization for blunt abdominal trauma, which may include transfer, is common among children. The objective of this study was to determine whether there were differences in mortality, treatment, or length of stay between patients treated at or transferred to a higher level trauma center and those not transferred and admitted to a lower level trauma center.
Methods:
Cohort from Washington state trauma registry from 2000 to 2014 of patients 16 years or younger with isolated Grade I-III spleen, liver, or kidney injury.
Results:
Among 54,034 patients 16 years or younger, the trauma registry captured 1177 (2.2%) patients with isolated low grade solid organ injuries; 226 (19.2%) presented to a higher level trauma center, 600 (51.0%) presented to a lower level trauma center and stayed there for care, and 351 (29.8%) were transferred to a higher level trauma center. Forty (3.4%) patients underwent an abdominal operation. Among the 950 patients evaluated initially at a lower level trauma center, the risk of surgery did not differ significantly between those who were not transferred compared to those who were (relative risk, 2.19; 95% confidence interval, 0.80-6.01). The risk of total splenectomy was no different for patients who stayed at a lower level trauma center compared with those who were transferred to a higher level trauma center (RR, 0.84; 95% CI, 0.33-2.16). Nontransferred patients had a 0.63 (95% confidence interval, 0.45-0.88) times lower risk of staying in the hospital for an additional day compared with patients who were transferred to a higher level trauma center. One patient died.
Conclusion:
Few pediatric patients with isolated low grade blunt solid organ injury require intervention and thus may not need to be transferred; trauma systems should revise their transfer policies. Prevention of unnecessary transfers is an opportunity for cost savings in pediatric trauma.
Level Of Evidence:
Therapeutic/Care management, level III.
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