Related Experiment Video
Updated: Jun 18, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Operative Management and Time to Procedure for Transferred versus Direct-arrival Supracondylar Humerus Fractures at a
David R Nelson1, Alexander J Kinstedt2, Zachary T Sheff3
1Peyton Manning Children's Hospital at Ascension St. Vincent, Indianapolis, IN, USA.
Background:
To evaluate operative management patterns and time to procedure for pediatric supracondylar humerus fractures at a non-trauma-designated children's hospital, comparing interfacility transfers with direct arrivals, and to assess whether transfer status may serve as an early indicator of surgical resource needs.
Methods:
We performed a retrospective cohort study of patients aged ≤14 years with supracondylar humerus fractures presenting to the emergency department of a Midwestern non-trauma-designated children's hospital (2010-2020). Outcomes included operative management, immediate surgery during the index encounter versus deferred surgery (return visit), and receiving-hospital arrival-to-procedure start time. Firth's penalized logistic regression was used for binary outcomes and linear regression of log-transformed time to identify independent predictors.
Results:
Among 464 patients, 136 (29.3%) were interfacility transfers. Transferred patients more frequently underwent surgery (94.1% vs 44.2%) and immediate surgery during the index encounter (91.9% vs 37.5%). Despite traveling a mean of 46 miles, transfers had shorter receiving-hospital arrival-to-procedure start times than direct arrivals (mean: 4.6 vs 6.3 h; 27% shorter; P < .001). In adjusted models, transfer status was associated with operative management (adjusted odds ratio [aOR]: 19.9; 95% confidence interval [CI]: 9.4-42.2), immediate surgery (aOR: 7.0; 95% CI: 2.0-24.2), and shorter receiving-hospital arrival-to-procedure start time (adjusted time ratio: 0.86; model P < .001). Among within-system transfers with segment timestamps, first-hospital arrival-to-procedure start time was comparable to direct arrivals' receiving-hospital arrival-to-procedure start time for distances <100 miles.
Conclusions:
Transferred patients at a non-trauma-designated children's hospital had shorter receiving-hospital intervals to procedure start despite additional travel, likely reflecting pre-arrival triage and early activation. Transfer status-known at arrival-may function as a practical signal to initiate surgical team mobilization and operating room preparation.
Key Concepts:
(1)At a non-trauma-designated children's hospital, transferred pediatric supracondylar humerus fracture patients underwent surgery more often (94.1% vs 44.2%) and had shorter receiving-hospital arrival-to-procedure start times (mean 4.6 vs 6.3 h) than direct arrivals.(2)Transfer status was the strongest independent indicator of operative management, immediate surgery during the index encounter and shorter receiving-hospital arrival-to-procedure start time in adjusted models.(3)Among within-system transfers with segment timestamps, first-hospital arrival-to-procedure start time for distances <100 miles was comparable to direct arrivals' receiving-hospital arrival-to-procedure start time, suggesting transport time may be offset by parallel pre-arrival preparation.(4)Within transferred patients, nighttime arrival and transport durations longer than expected were associated with substantially longer time to procedure start.(5)Because transfer status is known at arrival, it may serve as a practical trigger for early orthopaedic team activation and operating room preparation.
Level Of Evidence:
III (retrospective comparative study).
