Pediatric transfer propensity across United States emergency departments

Pediatric inpatient care is increasingly regionalized. To quantify how the propensity to transfer children varies across emergency departments (EDs) with different annual pediatric ED admission and transfer volumes, we analyzed the Nationwide Emergency Department Sample (2018-2022). Of 6,264,829 encounters from an estimated 4481 hospital-based EDs, the top 10% of EDs by admission and transfer volume accounted for 4,123,603 encounters (65.8%; 95% confidence interval [CI]: 62.9-68.7). While 1,933,609 (30.9%; 28.4-33.4) encounters resulted in transfer, 1,497,167 of 2,141,226 (69.9%; 95% CI: 68.5-71.3) were transferred after excluding encounters from the top 10% of EDs. Transfer rates increased over the study period for the bottom 90% of EDs (1.24% per year; 95% CI: 0.28-2.20, p = .011). The propensity to transfer children from the ED is greater among hospitals that admit or transfer fewer children and has recently increased among most EDs.