Preventable pediatric trauma transfers in a rural state
Derek J Krinock1, Savannah Walker1, Macllain Edington2
1Department of Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA; Division of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA.
Insights
One-quarter of pediatric trauma transfers were potentially preventable, with many discharged from the ED. Injury severity impacts transfer necessity, suggesting telemedicine could improve pediatric trauma triage.
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.
Background:
In rural settings, children with traumatic injuries are often first evaluated by providers at non-pediatric-specialized facilities who determine if the patient's condition warrants transfer. We sought to evaluate potentially preventable transfers (PTs) in the pediatric trauma population of our rural state.
Methods:
We performed a single-site retrospective cohort study at a level 1 pediatric trauma center, evaluating patients <18 years who presented as activated trauma transfers from referring facility between 1/2018-12/2023. PTs were defined as patients who were discharged from the Emergency Department or admitted for <24 h without requiring operative or procedural intervention, cross-sectional imaging or ICU admission following transfer. Bivariate analysis compared PTs to patients characterized as unpreventable transfers (UPTs) and multivariable logistic regression determined predictors of PT.
Results:
We included 762 patients with mean age 12 years (IQR 5,15) and 65% (n = 496) male. Twenty-five percent (n = 191) were characterized as PTs, with 112 patients discharging from the Emergency Department after transfer. PTs had a lower median injury severity score than UPTs (6 versus 17, p < 0.001). Mechanism of injury was not associated with PT (p = 0.172). Injury to the head (p < 0.001), chest (p = 0.009), abdomen (p = 0.012), appendicular skeleton (p < 0.001), and nonaccidental trauma (p = 0.002) were associated with UPT.
Conclusions:
One-quarter of activated trauma transfers were classified as potentially preventable, with over half of those patients being discharged from the Emergency Department. Several factors were associated with PTs, most notably injury severity. Telemedicine consultation with a pediatric trauma team may provide a potential method to improve pre-transfer triage for mild and moderately injured children.
Level Of Evidence:
Level III, Prognostic/Epidemiological.
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