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"Who is the right patient?" Insights into decisions to transfer pediatric trauma patients
Sydney Candy1, Nadine Schuurman2, Alison MacPherson3
1Queen's University, School of Medicine, Kingston, ON, Canada; University of Calgary, Department of Surgery, Calgary, AB, Canada.
Insights
Physician decisions to transfer pediatric trauma patients from Level III Trauma Centers (L3TCs) to Pediatric Trauma Centers (PTCs) depend on injury severity and patient age. Developing triage criteria with L3TC input ensures optimal outcomes while keeping families local.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Surgical Triage
Background:
- Transferring pediatric patients from Level III Trauma Centers (L3TCs) to Pediatric Trauma Centers (PTCs) involves complex decision-making.
- Understanding the variables influencing these transfers is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To identify factors influencing emergency physician decisions regarding the transfer of pediatric patients from L3TCs to PTCs.
- To examine the association between specific injury parameters, patient demographics, and physician characteristics with transfer recommendations.
Main Methods:
- A prospective cross-sectional survey was conducted involving emergency physicians at L3TCs and PTCs.
- Physicians were presented with clinical scenarios of pediatric patients and asked about transfer recommendations based on injury parameters (age, GCS, hemodynamic status, specific injuries) and physician demographics.
Main Results:
- Pelvic and gastrointestinal injuries, Glasgow Coma Scale (GCS) < 12, and age < 4 years were associated with transfer recommendations.
- L3TC physicians were less likely than PTC physicians to recommend transfer for femur fractures, solid organ/GI injuries, or GCS < 13.
- Factors like larger town size, surgeon experience, and emergency medicine training at L3TCs correlated with decisions against transfer.
Conclusions:
- The decision to transfer pediatric trauma patients is primarily driven by the need for surgery or critical care.
- For less severe cases or older children, L3TC physician input is vital for developing triage criteria that balance optimal outcomes with family proximity.
Objective:
We aim to determine what variables may influence physician decision-making about transfer of pediatric patients from a Level III Trauma Center (L3TC) to a Pediatric Trauma Center (PTC).
Methods:
Emergency L3TC physicians and PTC emergency physicians/TTLs were surveyed with clinical scenarios of children presenting to a L3TC with 5 injury parameters: age, hemodynamic status, GCS, intra-abdominal injury, femur/ pelvic fracture, and asked if the patient should be transferred to a PTC. Associations between parameters and physician demographics in the decision to transfer were examined.
Results:
One hundred seven and 94 surveys were completed at L3TCs and PTCs, respectively. Parameters associated with decision to transfer: pelvic and GI tract injuries, GCS < 12, and age < 4 years. L3TCs were significantly less likely vs. PTCs to recommend transfer with femur fracture, solid organ / GI injury, or a GCS of <13. Increasing town size, access to an experienced surgeon, and formal training in emergency medicine among L3TC physicians were associated with a decision not to transfer.
Conclusions:
Injuries requiring potential surgery or critical care influenced the decision to transfer. For cases with lesser severity or older ages, input of L3TCs on developing triage criteria is vital to allow families to stay in their home communities while ensuring optimal clinical outcomes.
Type Of Study:
Prospective Cross Sectional Survey.
Level Of Evidence:
Level III.
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