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Effect of a statewide pediatric trauma collaborative on preventable transfer rates and character
Jack H Scaife1, Christopher E Clinker, Anastasia M Kahan
1Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Insights
The Utah Pediatric Trauma Network (UPTN) reduced preventable patient transfers by standardizing care. This trauma network decreased overtriage, particularly for traumatic brain injuries, improving pediatric trauma outcomes.
Area of Science:
- Pediatric Trauma Care
- Health Services Research
- Epidemiology
Background:
- The Utah Pediatric Trauma Network (UPTN) was established in 2019 to standardize evidence-based guidelines for pediatric trauma care across Utah.
- This study evaluated the impact of the UPTN on the volume and nature of preventable transfers (PTs) to the state's sole Level I pediatric trauma center.
Purpose of the Study:
- To assess the correlation between the establishment of the UPTN and changes in the rate and characteristics of preventable pediatric trauma transfers.
- To determine if a regional trauma network effectively reduces overtriage in pediatric patients.
Main Methods:
- Retrospective analysis of children with traumatic injuries transferred between 2013 and 2023.
- Defined exposure as transfers occurring after UPTN establishment (January 1, 2019).
- Identified preventable transfers (PTs) as patients discharged within 48 hours without surgery or advanced imaging.
Main Results:
- A total of 6,036 pediatric transfers were analyzed; 3,025 pre-UPTN and 3,011 post-UPTN.
- The overall preventable transfer rate decreased significantly from 36% pre-UPTN to 29% post-UPTN (p < 0.001).
- Post-UPTN, there was a reduced proportion of transfers for intracranial bleeds (15% vs. 20%) and blunt solid organ injuries (4.3% vs. 5.5%), with a higher proportion for orthopedic injuries (36% vs. 28%). The PT rate for intracranial bleeds decreased from 47% to 37% (p < 0.001).
Conclusions:
- Establishment of a regional trauma network significantly decreased the overall rate of preventable pediatric trauma transfers.
- Traumatic brain injuries experienced the most substantial reduction in both transfer proportion and preventable transfer rates.
- Trauma networks serve as effective tools for reducing overtriage in pediatric trauma care.
Background:
The Utah Pediatric Trauma Network (UPTN), established in 2019, is a collaboration of hospitals in Utah that have implemented evidence-based guidelines to optimize pediatric trauma care. This study aimed to determine whether the establishment of the UPTN correlated with a change in the amount and character of preventable transfers (PTs) to the state's only Level I pediatric trauma center.
Methods:
Children with traumatic injuries transferred between 2013 and 2023 were retrospectively analyzed. The exposure was a transfer that occurred after the establishment of the UPTN on January 1, 2019. A PT was a child discharged within 48 hours of arrival without surgical intervention or advanced imaging studies.
Results:
During this period, 6,036 children were transferred. There were 3,025 transferred pre-UPTN, while 3,011 were transferred post-establishment. The rate of preventable transfer before the establishment was 36% versus 29% after ( p < 0.001). Following the establishment of the UPTN, there was a significant change in the proportion of each injury type that was transferred. A lower percentage of patients had an intracranial bleed (15% vs. 20%, p < 0.001), isolated skull fracture (6.8% vs. 8.8%; p = 0.004), or a blunt solid organ injury (4.3% vs. 5.5%, p = 0.031). There was an increase in the proportion of transferred patients that had an orthopedic injury (36% vs. 28%, p < 0.001) with a significant decrease in PT rate (10% vs. 15%, p = 0.003). In addition, after the UPTN was established, the preventable transfer rate for intracranial bleed significantly decreased from 47% to 37% ( p < 0.001).
Conclusion:
In this study, we found that following the establishment of a trauma network that standardized pediatric trauma guidelines across a region, the rate of preventable transfer decreased. Traumatic brain injuries saw the largest decrease in the proportion of transfers and the rate of preventable transfers. These findings give evidence of trauma networks being a practical tool for decreasing overtriage.
Level Of Evidence:
Prognostic/Epidemiological; Level IV.
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