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Pediatric Injury Transfer Patterns During the COVID-19 Pandemic: An Interrupted time Series Analysis
Katherine T Flynn-O'Brien1, Amelia T Collings2, Manzur Farazi1
1Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Children's Wisconsin, Milwaukee, Wisconsin.
Insights
During the COVID-19 pandemic, interfacility transfers of injured children to pediatric trauma centers increased. More transferred pediatric trauma patients were discharged home, indicating potential strain on emergency departments.
Area of Science:
- Pediatric Trauma Care
- Public Health Emergencies
- Healthcare System Capacity
Background:
- The COVID-19 pandemic prompted recommendations for diverting pediatric patients to specialized centers.
- Understanding the impact on interfacility transfers to Pediatric Trauma Centers (PTCs) is crucial.
Purpose of the Study:
- To analyze changes in interfacility transfers to PTCs during the initial six months of the COVID-19 pandemic.
- To compare pediatric trauma transfer volumes and characteristics between the pandemic period and a historical average.
Main Methods:
- Utilized interrupted time-series analysis on data from 9 PTCs for children injured between 2016 and 2020.
- Compared a 'COVID' cohort (pandemic period) with a historical average (HA) cohort (2016-2019).
- Assessed differences in transfer volume, demographics, injury severity, and outcomes.
Main Results:
- A significant increase in transferred patients to PTCs was observed during the COVID-19 cohort compared to the HA cohort (65.4% vs 55.7%).
- The COVID cohort showed a decrease in older pediatric patients (15-17 years) and an increase in patients with lower injury severity scores (≤15).
- A higher proportion of patients in the COVID cohort were discharged directly home from the PTC (31.8% vs 21.83%).
Conclusions:
- Interfacility transfers of pediatric trauma patients to Level I PTCs increased during the COVID-19 pandemic.
- The rise in transfers and direct discharges suggests potential impacts on referring emergency department capacity and pediatric trauma triage capabilities.
- Pediatric trauma transfers may serve as an indicator of healthcare system strain during public health crises.
Introduction:
With the expected surge of adult patients with COVID-19, the Children's Hospital Association recommended a tiered approach to divert children to pediatric centers. Our objective was understanding changes in interfacility transfer to Pediatric Trauma Centers (PTCs) during the first 6 mo of the pandemic.
Methods:
Children aged < 18 y injured between January 1, 2016 and September 30, 2020, who met National Trauma Databank inclusion criteria from 9 PTCs were included. An interrupted time-series analysis was used to estimate an expected number of transferred patients compared to observed volume. The "COVID" cohort was compared to a historical cohort (historical average [HA]), using an average across 2016-2019. Site-based differences in transfer volume, demographics, injury characteristics, and hospital-based outcomes were compared between cohorts.
Results:
Twenty seven thousand thirty one/47,382 injured patients (57.05%) were transferred to a participating PTC during the study period. Of the COVID cohort, 65.4% (4620/7067) were transferred, compared to 55.7% (3281/5888) of the HA (P < 0.001). There was a decrease in 15-y-old to 17-y-old patients (10.43% COVID versus 12.64% HA, P = 0.003). More patients in the COVID cohort had injury severity scores ≤ 15 (93.25% COVID versus 87.63% HA, P < 0.001). More patients were discharged home after transfer (31.80% COVID versus 21.83% HA, P < 0.001).
Conclusions:
Transferred trauma patients to Level I PTC increased during the COVID-19 pandemic. The proportion of transferred patients discharged from emergency departments increased. Pediatric trauma transfers may be a surrogate for referring emergency department capacity and resources and a measure of pediatric trauma triage capability.
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