Interhospital transfer amongst injured children in New South Wales, Australia

Injury is a leading cause of hospitalisation amongst children in Australia. Interhospital transfer (IHT) is one strategy by which children can receive trauma care at a specialised centre. We aim to quantify the use of IHT for injured children in New South Wales (NSW) and determine the patient- and hospital-related factors associated with IHT.

This is a retrospective cohort study of statewide administrative data from 1st July 2001 to 31st March 2019. The primary outcome of interest is the use of IHT. Logistic regression model was used to estimate Odds Ratios and their 95 % confidence interval. Additional analyses were performed at the hospital level with a secondary outcome of transfer-rate.

242,911 children were admitted to an NSW hospital with an injury; 1.3 % (n = 3296) of these children underwent IHT, of whom 2557 (77 %) had minor injuries. Severe injury (OR 13.56, p < 0.0001) and presenting to a rural local hospital (RLH) (OR 15.48, p < 0.0001) had especially strong associations with the use of IHT. Not all transfers were to designated trauma centres. There was also considerable variation in the rate of IHT use between hospitals.

IHT resulted in over 3000 transfers during the study period, mostly for minor injuries. While guidelines exist for field triage and IHT of the severely injured child, similar guidance may be useful for children with minor injuries. Transfer rates and destinations were not consistent across hospitals within a trauma classification, presenting an opportunity for improving health-system efficiency and patient-centred care.