Outcomes of children transferred to a pediatric trauma center after blunt abdominal trauma: A 10-year experience.

BACKGROUND

Most injured children are initially seen at non-pediatric hospitals, then transferred to a pediatric trauma center for definitive care. Published outcomes of transferred children with blunt abdominal trauma (BAT) are sparse. Our objective is to describe this population and their disposition at a pediatric trauma center.

METHODS

The study was performed at a level-1 pediatric trauma center (PTC) using data collected from electronic medical records and trauma registry. Patients 0-18 years with BAT transferred from outside facilities (OSF) between 2009 and 2019. Penetrating injuries were excluded. 923 patients were analyzed and grouped by whether computed tomography abdominal/pelvis (CTa/p) was obtained at each facility. Those with positive CTa/p at OSF were also compared to those with positive CTa/p results at our PTC. Descriptive statistics evaluated demographics, injury mechanism, Glasgow Coma Scale (GCS), Injury Severity Scale (ISS), disposition, and length of stay (LOS).

RESULTS

Males had higher predominance of positive CTa/p at both OSF and PTC (p = 0.0012), with motor vehicle crash (MVC) being the most common injury mechanism (p = 0.0002). Patients with positive CTa/p at PTC (n = 156) were associated with statistically higher ISS, lower GCS, more dispositions to OR and ICU, and longer LOS (all p < 0.005). Of patients with negative CTa/p at OSF (n = 41), none received subsequent CTa/p upon arrival to PTC and only 2 were admitted in the setting of head trauma. Of the patients without CTa/p performed at either facility or negative CTa/p at PTC (n = 23), most were admitted for non-abdominal trauma.

CONCLUSION

Compared to those with positive CTa/p at OSF, children who had positive CTa/p at PTC were younger, had higher ISS scores, and longer LOS, suggesting they were more seriously injured. Children with BAT and negative CTa/p in absence of other injuries, may not require transfer to a PTC. Enhanced understanding of these patients may reduce unnecessary transfers, improving resource utilization.