The American journal of emergency medicine · 2026
Predictors and economic impact of potentially avoidable transfers in facial fractures among pediatric populations: A 15-year analysis.
СтатьяНазвание и аннотация: Перевод в очереди
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Cheng Lucille G, Liu Shirley X, Dhariwal Aniket, Glenney Anne E, Ocasio-Nieves Brian, Somorin Tobi, Kass Nicolás M, Dvoracek Lucas A, David Joshua A, Kueper Janina, Saladino Richard A, Goldstein Jesse A
Аннотация
BACKGROUND: Transfers of children with minor injuries, rather than complex trauma requiring specialized care, create unnecessary strain on patients, families, and healthcare resources. While existing research has examined transfers for specific injury categories, our study comprehensively investigates the factors driving potentially avoidable transfers (PATs) among pediatric patients with diverse facial fracture presentations, as well as the economic impact associated with these transfers.
METHODS: A retrospective analysis examined facial fractures in pediatric patients at our level I pediatric trauma center from 2006 to 2021. We defined Potentially Avoidable Transfers (PATs) as cases with hospital stays under 24 h, no admission, no surgery, and no emergency or specialized procedures post-transfer. We analyzed demographics, medical history, injury characteristics, associated injuries, treatments, and outcomes using logistic regression, chi-square, or Fisher's exact tests in Stata SE Software (Version 17.0, College Station, TX).
RESULTS: Of 3334 pediatric patients identified, 3132 patients met inclusion criteria; of these, 1251 (40.1%) were transferred from a community hospital and 297 (23.7%) met our definition of a PAT. Potentially avoidable transfers were predominantly male (n = 217, 73.1%) and 11 years of age on average. Key patient characteristics associated with PAT were lack of medical insurance (p = 0.004, OR = 1.83), age less than six years age (p = 0.007, OR = 1.98), and the presence of an orbital or mandible fracture (p = 0.001, OR = 1.83). A single PAT incurred a cost of $2125.90 at the receiving hospital, with most expenses resulting from imaging and laboratory tests.
CONCLUSIONS: PATs impose substantial logistical and economic challenges for patients and healthcare systems. We propose developing transfer protocols to enhance clinical decision-making, potentially reducing unnecessary transfers while ensuring patient safety. Remote specialist consultation for pediatric patients could also optimize care by minimizing unwarranted transfers.
METHODS: A retrospective analysis examined facial fractures in pediatric patients at our level I pediatric trauma center from 2006 to 2021. We defined Potentially Avoidable Transfers (PATs) as cases with hospital stays under 24 h, no admission, no surgery, and no emergency or specialized procedures post-transfer. We analyzed demographics, medical history, injury characteristics, associated injuries, treatments, and outcomes using logistic regression, chi-square, or Fisher's exact tests in Stata SE Software (Version 17.0, College Station, TX).
RESULTS: Of 3334 pediatric patients identified, 3132 patients met inclusion criteria; of these, 1251 (40.1%) were transferred from a community hospital and 297 (23.7%) met our definition of a PAT. Potentially avoidable transfers were predominantly male (n = 217, 73.1%) and 11 years of age on average. Key patient characteristics associated with PAT were lack of medical insurance (p = 0.004, OR = 1.83), age less than six years age (p = 0.007, OR = 1.98), and the presence of an orbital or mandible fracture (p = 0.001, OR = 1.83). A single PAT incurred a cost of $2125.90 at the receiving hospital, with most expenses resulting from imaging and laboratory tests.
CONCLUSIONS: PATs impose substantial logistical and economic challenges for patients and healthcare systems. We propose developing transfer protocols to enhance clinical decision-making, potentially reducing unnecessary transfers while ensuring patient safety. Remote specialist consultation for pediatric patients could also optimize care by minimizing unwarranted transfers.