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Effect of Interfacility Transfer on Outcomes in Pediatric Severe Traumatic Brain Injury Patients
Sanjan Kumar1, Philip Lee, Brian Chin
1Author Affiliations: University of Central Florida College of Medicine, Orlando, Florida (Mr Kumar and Mr Yates); John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii (Mr Lee and Mr Chin); Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida (Mr Nasef); William Carey University College of Osteopathic Medicine, Hattiesburg, Mississippi (Mr Ford); University of Miami Miller School of Medicine, Miami, Florida (Mr Bundschu); Department of Pediatric Surgery, Arnold Palmer Children's Hospital, Orlando Health, Orlando, Florida (Dr Plumley); and Departments of Surgery and Surgical Education, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida (Dr Elkbuli).
Insights
Transferring pediatric severe traumatic brain injury (TBI) patients to higher-level trauma centers increases neurosurgical interventions and home discharge rates. Mortality remains unchanged, highlighting improved care coordination for TBI patients.
Area of Science:
- Trauma Surgery
- Pediatric Neurosurgery
- Critical Care Medicine
Background:
- Limited research exists on pediatric traumatic brain injury (TBI) transfers to higher-level trauma centers.
- Existing studies often overlook key outcomes like early discharge, ICU length of stay, and discharge disposition.
Purpose of the Study:
- To evaluate the impact of transfer to a higher-level trauma center on clinical outcomes for pediatric severe TBI patients.
- To analyze associations between transfer status and neurosurgical intervention, discharge timing, and disposition.
Main Methods:
- Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program (2017-2023).
- Inclusion criteria: pediatric trauma patients with isolated severe TBI transferred from lower- to higher-level trauma centers.
- Primary outcomes: odds of discharge within 24/48 hours without neurosurgery, and rates of neurosurgical intervention.
Main Results:
- Of 4,154 pediatric severe TBI patients, 41.5% were transferred.
- Transferred patients had lower odds of early discharge without neurosurgery (OR: 0.58) but higher odds of undergoing neurosurgical intervention (OR: 1.26).
- Transfer was associated with increased likelihood of discharge home (OR: 1.58), with no significant difference in mortality.
Conclusions:
- Transfer to higher-level trauma centers is linked to increased neurosurgical interventions in pediatric severe TBI.
- Higher-level trauma center transfer is associated with improved discharge home rates for pediatric severe TBI patients.
- Mortality rates are comparable between transferred and non-transferred pediatric severe TBI patients.
Background/Rationale:
Existing literature on pediatric traumatic brain injury (TBI) transfers to higher-level trauma centers is limited. Most studies focus on inhospital mortality and neurosurgical intervention rates, often overlooking outcomes such as early discharge without neurosurgical intervention, intensive care unit length of stay, and discharge disposition.
Objectives:
To assess the impact of transfer to a higher-level trauma center on clinical outcomes of pediatric severe TBI patients.
Methods:
This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program database between 2017 and 2023 to evaluate pediatric trauma patients with isolated severe TBI transferred from lower-level to higher-level trauma centers. The primary outcome was the odds of discharge within 24 or 48 h without requiring neurosurgical intervention and rates of neurosurgical intervention. Secondary outcomes included emergency department and 24-h mortality, initial and repeat computerized tomography scan rates, intensive care unit length of stay, ventilator-free days, and discharge home.
Results:
Of the 4,154 pediatric patients with isolated severe TBI, 1,723 (41.5%) were transferred, and 2,418 (58.2%) were not. Transferred patients had a 42% lower odds of discharge within 24 h without neurosurgical intervention (OR: 0.58, 95% CI [0.41, 0.80], p < .001), were more likely to undergo neurosurgical intervention (OR: 1.26, 95% CI [1.04, 1.53], p = .016), and were more likely to be discharged home (OR: 1.58, 95% CI [1.30, 1.92], p < .001). Mortality rates did not differ significantly between groups.
Conclusion:
Transfer to higher-level trauma centers is associated with increased neurosurgical intervention and higher rates of discharge home in pediatric patients with severe TBI, without differences in mortality.
