Association Between Hospital Arrival Time and Avoidable Transfer in Pediatric Trauma

Abstract

BackgroundAvoidable transfers (AT) in pediatric trauma can increase strain on healthcare resources and families. We sought to identify characteristics of patients and their injuries that are associated with AT. MethodsA multicenter retrospective cross-sectional study of the regional Trauma Registry was conducted from 1/1/10–12/31/21 of children <18 years-old who experienced an interfacility transfer. AT was defined as receiving hospital length of stay (LOS) < 48 hrs without procedure or intervention performed. Patient demographics, mechanism of injury, and arrival time were analyzed with descriptive statistics. A multivariable logistic regression was performed to analyze demographic and clinical factors associated with AT. ResultsWe included 5438 trauma transfers, of which 2187 (40.2%) were AT. Patients experiencing AT had a median [IQR] age of 5 years [1–12] and most were male (67%) and Hispanic/Latino (46.3%). The odds of experiencing AT decreased as age increased and were less likely in females and Non-Hispanic Black children. Injuries from falls (ground level (OR = 2.48; 95%CI = 1.89–3.28) and >10 ft (OR = 3.20; 95%CI = 2.35–4.39)), sports/recreational activities (OR = 2.36; 95%CI = 1.78–3.16), MVCs (OR = 1.44; 95%CI = 1.05–1.98), and firearms (OR = 1.74; 95%CI = 1.15–2.62) were associated with an increased odds of AT. Time of arrival at the receiving facility in early hours (00:00–07:59) (OR = 1.48; 95%CI = 1.24–1.76) and evening hours (17:00–23:59) (OR = 1.75; 95%CI = 1.47–2.07) were associated with an increased odds of AT. ConclusionYounger patients, injuries from falls, sports/recreational activities, MVCs, and firearms as well as arrival time outside of standard work hours are more likely to result in AT. Knowing these results, we can begin working with our referral centers to improve communication and strengthen institutional transfer criteria for pediatric trauma patients. Further investigation will then be needed to determine if the changes implemented have influenced care and lowered rates of avoidable transfer. Level of evidenceLevel III.