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Outcomes After Transfer of Pediatric Trauma Patients: Does Everyone Need to Visit the Trauma Bay?
Michelle T Nguyen1, Andrew H Kim2, Erik R Barthel3
1Department of Pediatrics, Valley Children's Hospital, Madera, California.
Insights
Critically injured pediatric patients transferred directly to the pediatric intensive care unit (ICU) bypass the emergency department without increased mortality or delayed interventions. This approach is safe for select pediatric trauma cases.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Critical Care
Background:
- Critically injured children and teens are often transferred between facilities.
- Limited data exists on the optimal transfer pathway for pediatric patients to the pediatric intensive care unit (ICU).
- Uncertainty surrounds whether direct ICU transfer or initial emergency department evaluation is safer and more efficient.
Purpose of the Study:
- To evaluate the safety and efficiency of direct transfer to the pediatric intensive care unit (ICU) versus initial emergency department evaluation for critically injured pediatric patients.
- To compare outcomes, including mortality and time to intervention, between the two transfer pathways.
Main Methods:
- Retrospective analysis of an institutional trauma registry over three years.
- Comparison of transferred trauma patients, evaluating those initially seen in the emergency room versus those transferred directly to the ICU.
- Key outcome measures included time to imaging, time to operating room, and overall mortality.
Main Results:
- No increased mortality was observed for patients transferred directly to the ICU after adjusting for other variables.
- Unadjusted mortality was higher in the direct ICU transfer group, but these patients had lower Glasgow Coma Scale scores and higher Pediatric Risk of Mortality scores, indicating more severe injuries.
- No significant delays in imaging or procedures were noted for patients transferred directly to the ICU.
Conclusions:
- Direct transfer to the pediatric intensive care unit (ICU), bypassing the emergency department, is a safe strategy for select pediatric trauma patients previously assessed at another institution.
- This transfer pathway does not appear to worsen patient outcomes or delay necessary interventions.
- The findings support direct ICU transfer as a viable option, potentially improving efficiency in pediatric trauma care.
Introduction:
Critically injured children and teens often present to adult trauma centers or nontrauma facilities prior to transfer to a pediatric trauma center. For pediatric patients wanting transfer to the intensive care unit (ICU), there is little data to guide which can be safely transferred directly to the unit, and which should be evaluated first in the trauma bay.
Methods:
We used our institutional trauma registry to evaluate transferred trauma patients over a three year period. We compared time to imaging, time to operating room, and overall mortality between the group evaluated first in the emergency room and those transferred directly to the ICU.
Results:
When adjusted for other variables, there was no increased mortality in those transferred directly to the ICU. While there was a higher nonadjusted mortality in those transferred to the ICU (13% versus 3.7%), these nonsurvivors had a lower GCS (3 versus 13), higher Pediatric Risk of Mortality scores, and a high rate of severe head trauma. There was no significant delay in ordered imaging or procedures.
Conclusions:
In patients, who have been assessed at another institution prior to transfer to the pediatric ICU, transfer directly to the ICU, bypassing the emergency department, does not delay interventions and does not appear to worsen outcomes.
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