Does destination make a difference? Outcomes after a policy change affecting cutoff times for pre-hospital transport.

Abstract

Facilitating primary triage and care at Pediatric Trauma Centers (PTCs) can improve outcomes for children after trauma. However, scene location and regional EMS regulations may result in initial evaluation occurring at non-pediatric facilities with later transportation to PTCs for definitive care. In this study, we assessed the results of a change in transport time cutoff from 30 to 45 minutes on pediatric patient outcomes. After IRB approval, the Pediatric Trauma Database at a level 1 PTC was queried for patients seen before (January 1, 2015-December 31, 2017) and after (January 1, 2018-December 31, 2020) the implementation of a policy increasing transport cutoff time from 30 to 45 minutes. Patient outcomes were compared by transport status and ISS using generalized linear regression analysis. 505 patients were seen pre and 413 patients post policy changes. Both groups had similar numbers of severely injured patients (ISS ≥ 15, 64 (13%) pre and 61 (15%) post). Average transport time increased post change (pre 20 min (95% CI[18,22] min), post 29 min (95% CI[26,33] min, p = 0.0252), consistent with policy compliance. The proportion of transferred patients did not change after policy implementation (p = 0.5856), and the complications among all patients with ISS ≥ 15 did not significantly decrease (pre 75%, post 65.6%). However, those patients with ISS ≥ 15 admitted directly from the scene had a lower frequency of complications after the policy changes (pre 76%, post 59%, p = 0.0319), and in the post period transferred patients with an ISS ≥ 15 had a higher complication rate than those admitted directly from the scene (p < 0.0001). Direct scene admission to a PTC is associated with a lower complication profile for patients with higher ISS. Methods to ensure adherence to cutoff thresholds for EMS transport may have a positive benefit on patient outcomes. IV, prognostic/epidemiological.