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Association Between Hospital Arrival Time and Avoidable Transfer in Pediatric Trauma
MaKayla L O'Guinn1, Alice M Martino1, Shadassa Ourshalimian1
1Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA.
Insights
Younger children, falls, sports injuries, and transfers outside standard hours increase avoidable transfers in pediatric trauma. Identifying these factors can help reduce healthcare strain and improve patient care.
Area of Science:
- Pediatric Trauma Care
- Healthcare Resource Management
- Patient Transfer Protocols
Background:
- Avoidable transfers (AT) in pediatric trauma place significant strain on healthcare systems and families.
- Identifying factors associated with AT is crucial for optimizing resource allocation and patient outcomes.
Purpose of the Study:
- To identify patient and injury characteristics associated with avoidable transfers in pediatric trauma.
- To analyze demographic and clinical factors influencing interfacility transfer decisions for pediatric trauma patients.
Main Methods:
- Multicenter retrospective cross-sectional study using a regional Trauma Registry (2010-2021).
- Inclusion criteria: pediatric patients (<18 years) experiencing interfacility transfer.
- AT defined as <48 hours length of stay at the receiving hospital without procedures; multivariable logistic regression used for analysis.
Main Results:
- 40.2% of 5438 pediatric trauma transfers were classified as AT.
- Younger age, male sex, and Hispanic/Latino ethnicity were associated with higher AT rates.
- Falls, sports/recreational activities, motor vehicle collisions (MVCs), and firearm injuries increased odds of AT.
- Transfers occurring during early morning (00:00-07:59) and evening (17:00-23:59) hours were more likely to be AT.
Conclusions:
- Younger pediatric trauma patients, specific injury mechanisms (falls, sports, MVCs, firearms), and off-hours arrivals are linked to higher rates of AT.
- Findings suggest a need for improved communication and refined transfer criteria at referral centers.
- Further research is warranted to evaluate the impact of implemented changes on reducing AT rates.
Background:
Avoidable transfers (AT) in pediatric trauma can increase strain on healthcare resources and families. We sought to identify characteristics of patients and their injuries that are associated with AT.
Methods:
A multicenter retrospective cross-sectional study of the regional Trauma Registry was conducted from 1/1/10-12/31/21 of children <18 years-old who experienced an interfacility transfer. AT was defined as receiving hospital length of stay (LOS) < 48 hrs without procedure or intervention performed. Patient demographics, mechanism of injury, and arrival time were analyzed with descriptive statistics. A multivariable logistic regression was performed to analyze demographic and clinical factors associated with AT.
Results:
We included 5438 trauma transfers, of which 2187 (40.2%) were AT. Patients experiencing AT had a median [IQR] age of 5 years [1-12] and most were male (67%) and Hispanic/Latino (46.3%). The odds of experiencing AT decreased as age increased and were less likely in females and Non-Hispanic Black children. Injuries from falls (ground level (OR = 2.48; 95%CI = 1.89-3.28) and >10 ft (OR = 3.20; 95%CI = 2.35-4.39)), sports/recreational activities (OR = 2.36; 95%CI = 1.78-3.16), MVCs (OR = 1.44; 95%CI = 1.05-1.98), and firearms (OR = 1.74; 95%CI = 1.15-2.62) were associated with an increased odds of AT. Time of arrival at the receiving facility in early hours (00:00-07:59) (OR = 1.48; 95%CI = 1.24-1.76) and evening hours (17:00-23:59) (OR = 1.75; 95%CI = 1.47-2.07) were associated with an increased odds of AT.
Conclusion:
Younger patients, injuries from falls, sports/recreational activities, MVCs, and firearms as well as arrival time outside of standard work hours are more likely to result in AT. Knowing these results, we can begin working with our referral centers to improve communication and strengthen institutional transfer criteria for pediatric trauma patients. Further investigation will then be needed to determine if the changes implemented have influenced care and lowered rates of avoidable transfer.
Level Of Evidence:
Level III.
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