Preventable transfers in pediatric trauma: A 10-year experience at a level I pediatric trauma center. 2016

Stephen J Fenton, and Justin H Lee, and Austin M Stevens, and Kyle C Kimbal, and Chong Zhang, and Angela P Presson, and Ryan R Metzger, and Eric R Scaife
Division of Pediatric Surgery, University of Utah School of Medicine, Primary, Children's Hospital, Salt Lake City, UT, United States. Electronic address: stephen.fenton@hsc.utah.edu.

BACKGROUND Injured children are often treated at one facility then transferred to another that specializes in pediatric trauma care. The purpose of this study was to identify and characterize potentially preventable transfers (PT) to a freestanding level-I pediatric trauma center. METHODS Children with traumatic injuries transferred between 2003 and 2013 were retrospectively analyzed. A PT was defined as a child who was discharged within 36hours of arrival without surgical intervention or advanced imaging studies. RESULTS During this period, 6380 children were transferred, with head injury being the most common injury. 61% had CT imaging performed before transfer. The mean age was 6.9years, mean injury severity score (ISS) 10.4, and median transfer distance 37miles. 27% of these transfers were classified as PT. Air transport was used in 15% at mean charge of $18,574. 29% were discharged from the emergency department. When compared, PTs were younger (6.0 vs. 7.2years, p<0.001), with lower median ISS (5 vs. 9, p<0.001), shorter median LOS (15 vs. 43.6hours, p<0.001), and less PICU admissions (6% vs. 34%, p<0.001). CONCLUSIONS A significant number of pediatric trauma transfers can be classified as preventable. Reducing preventable transfers could offer opportunities for improving value in a trauma care system.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D008297 Male Males
D010351 Patient Discharge The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities. Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D010360 Patient Transfer Interfacility or intrahospital transfer of patients. Intrahospital transfer is usually to obtain a specific kind of care and interfacility transfer is usually for economic reasons as well as for the type of care provided. Patient Dumping,Care Transition,Health Care Transition,Patient Transition,Patient Turfing,Transition of Care,Care Transition, Health,Care Transitions,Care Transitions, Health,Dumping, Patient,Health Care Transitions,Patient Transfers,Patient Transitions,Patient Turfings,Transfer, Patient,Transfers, Patient,Transition, Care,Transition, Health Care,Transition, Patient,Transitions, Care,Transitions, Health Care,Transitions, Patient,Turfing, Patient,Turfings, Patient
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000069342 Medical Overuse Excessive or unnecessary utilization of health services by patients or physicians. Overutilization of Health Services,Unnecessary Health Care,Health Services Overuse,Health Services Overutilization,Medical Preference Misdiagnosis,Overuse, Health Services,Preference Misdiagnosis,Unwanted Medical Care,Health Care, Unnecessary,Health Services Overuses,Medical Care, Unwanted,Medical Overuses,Medical Preference Misdiagnoses,Misdiagnosis, Medical Preference,Misdiagnosis, Preference,Overuse, Medical,Overuses, Health Services,Overuses, Medical,Overutilization, Health Services,Preference Misdiagnoses

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