Association Between Hospital Arrival Time and Avoidable Transfer in Pediatric Trauma

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.