Preventable pediatric trauma transfers in a rural state

Area of Science:

• Pediatric Trauma Care
• Healthcare Systems Research
• Injury Epidemiology

Background:

• Rural pediatric trauma patients are often initially evaluated at non-specialized facilities.
• These facilities decide if a patient requires transfer to a specialized center.
• Evaluating potentially preventable transfers (PTs) is crucial for optimizing resource allocation.

Purpose of the Study:

• To evaluate the rate and predictors of potentially preventable transfers (PTs) in pediatric trauma patients from a rural state.
• To identify factors associated with PTs versus unpreventable transfers (UPTs).

Main Methods:

• Retrospective cohort study of pediatric trauma transfers (1/2018-12/2023) at a Level 1 pediatric trauma center.
• Defined PTs as transfers not requiring operative intervention, advanced imaging, or ICU admission.
• Utilized bivariate analysis and multivariable logistic regression to identify PT predictors.

Main Results:

• 25% (n=191) of 762 pediatric trauma transfers were classified as PTs.
• PTs had significantly lower injury severity scores compared to UPTs (median 6 vs 17).
• Injuries to the head, chest, abdomen, appendicular skeleton, and nonaccidental trauma were associated with UPTs.

Conclusions:

• A significant proportion of pediatric trauma transfers were potentially preventable.
• Lower injury severity was a key characteristic of PTs.
• Telemedicine consultations could enhance pre-transfer triage for less severely injured pediatric trauma patients.