Preventable pediatric trauma transfers in a rural state.

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.