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Published on: January 20, 2023
Factors associated with avoidable interhospital transfers for children with a minor head injury
Fabrice Mowbray1, Rajan Arora2, Meghna Shukla2
1Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8, Canada.
Insights
Nearly half of all pediatric head injury transfers were avoidable. Younger children and those with low head injury risk were more likely to have unnecessary transfers, highlighting areas for intervention.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Healthcare Management
Background:
- Minor head injuries (MHI) in children often lead to interhospital transfers to pediatric trauma centers.
- Unwarranted transfers increase healthcare costs without significant patient benefit.
Purpose of the Study:
- To identify factors associated with avoidable interhospital transfers for pediatric MHI.
- To inform strategies for reducing unnecessary patient transfers and associated costs.
Main Methods:
- Retrospective cohort study of children under 18 transferred for MHI (January 2013-December 2018).
- Exclusion criteria included non-accidental trauma and pre-existing neurological/coagulopathic conditions.
- Avoidable transfers were defined by the absence of specific interventions (e.g., sedation, ICU admission, surgery) at the receiving center.
Main Results:
- 42% of 1078 MHI transfers were classified as avoidable.
- Younger children (<2 years), those with low risk for clinically important traumatic brain injury (ciTBI), and those with a positive head CT at the transferring hospital were significantly associated with avoidable transfers.
- Factors associated with avoidable transfers included younger age (OR=1.75), low ciTBI risk (OR=1.66), and a positive head CT at the transferring hospital (OR=0.06).
Conclusions:
- A high rate of avoidable interhospital transfers exists for children with MHI.
- Targeting interventions based on identified risk factors can potentially reduce unnecessary transfers.
- Optimizing transfer criteria can improve resource allocation and reduce healthcare expenditures.
Introduction:
Children with minor head injuries (MHI) are routinely transferred to a pediatric trauma center for definitive care. Unwarranted transfers result in minimal benefit to the patient and add substantially to healthcare costs. The purpose of this study is to explore the factors associated with avoidable interhospital transfers of children with MHI.
Methods:
We conducted a retrospective cohort study of children <18 years of age transferred to our pediatric emergency department (PED) for MHI between January 2013 and December 2018. Patients transferred for non-accidental trauma, and those with a history of coagulopathies, underlying neurological conditions, intraventricular shunts and developmental delay were excluded. Transfers were categorized as avoidable if none of the following interventions were required at our PED: procedural sedation, anticonvulsant initiation, subspecialty consultation, intensive care unit admission or hospital admission for ≥2 nights, intubation or operative intervention. We collected demographics, injury mechanism, neuroimaging results, interventions performed and PED disposition. Binary logistic regression was conducted to provide adjusted associations between patient characteristics and the risk of avoidable interhospital transfers.
Results:
We analyzed 1078 transfers for MHI, of which 450 (42%) transfers were classified as avoidable. Children in the avoidable transfer group tended to be younger, less likely to have experienced loss of consciousness, and more likely to belong to the the group at lowest risk for a clinically important traumatic brain injury (ciTBI). Our multivariable model determined that children less than 2 years of age (OR = 1.75; 95% CI = 1.3-2.37), low-risk group for ciTBI (OR = 1.66; 95% CI = 1.22-0.1), and a positive head CT at the transferring hospital (OR = 0.06; 95% CI = 0.02-0.1) were all significantly associated with avoidable transfers.
Conclusion:
There is a high rate of avoidable transfers in children with MHI. Focused interventions targeting risk factors associated with avoidable transfers may reduce unwarranted interhospital transfers.
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