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Analysis of preventable transfers from Montana to out-of-state pediatric trauma centers: A multicenter collaboration
Abigail J Alexander1, Christopher Clinker, Jack Scaife
1From the Division of Pediatric Surgery, Department of Surgery (A.J.A., C.C., J.S., H.-Y.W., S.E.I., T.B., M.M., S.J.F., R.A.S., K.W.R.), University of Utah, Salt Lake City, UT; Harborview Medical Center (B.R., L.V.H.), University of Washington, Seattle, WA; Department of Surgery (S.N.A., C.M., A.I.), University of Colorado, Aurora, CO; St. Vincent Regional Hospital (L.F., B.A.M.), Intermountain Health, Billings, Montana; and Department of Geography (P.M.), and Division of Pediatric Emergency Medicine, Department of Pediatrics (J.A.R.), University of Utah, Salt Lake City, UT.
Introduction:
Because of the limited number of verified pediatric trauma centers (PTCs), transferring pediatric trauma patients to specialized facilities is essential for providing high-level trauma care. However, preventing transfers that are unnecessary is also crucial. For a state such as Montana, where there is no verified in-state PTC, understanding the types of transfers that could be prevented is critical to improving pediatric trauma care in this rural state. The purpose of this study was to identify and describe patients who underwent preventable transfer from hospitals across Montana to three Level I PTCs in surrounding states.
Methods:
We performed a multicenter retrospective review of all trauma patients younger than 18 years who underwent transfer from hospitals in Montana to the three closest out-of-state Level I PTCs from 2013 to 2022. The primary outcome, preventable transfer, was defined as discharge within 48 hours without advanced imaging (computed tomography or magnetic resonance imaging) or surgical intervention. We performed a secondary analysis to identify "possibly preventable transfers," which was defined as patients who could have been safely managed at an in-state Level I adult trauma center with certain pediatric specific capabilities.
Results:
Of 339 total patients transferred, 39 patients (12%) met the criteria for preventable transfer, and 63 patients (19%) met the criteria for possibly preventable transfer. The majority of preventable transfers were traumatic brain injuries (72%), followed by isolated orthopedic injuries (13%). Possibly preventable transfers included traumatic brain injuries (35%) and isolated orthopedic injuries (32%), among others. The median distance traveled was 544 miles for both groups, with an interquartile range of 413 to 558 miles for preventable transfers and 419 to 558 miles for the possibly preventable transfers.
Conclusion:
A significant proportion (31%) of pediatric trauma patients in Montana who underwent long-distance transfer to out-of-state Level I PTCs could potentially have received appropriate care closer to home.
Level Of Evidence:
Prognostic and Epidemiological; Level IV.
