Effect of a statewide pediatric trauma collaborative on preventable transfer rates and character.

Abstract

The Utah Pediatric Trauma Network (UPTN), established in 2019, is a collaboration of hospitals in Utah that have implemented evidence-based guidelines to optimize pediatric trauma care. This study aimed to determine whether the establishment of the UPTN correlated with a change in the amount and character of preventable transfers (PTs) to the state's only Level I pediatric trauma center. Children with traumatic injuries transferred between 2013 and 2023 were retrospectively analyzed. The exposure was a transfer that occurred after the establishment of the UPTN on January 1, 2019. A PT was a child discharged within 48 hours of arrival without surgical intervention or advanced imaging studies. During this period, 6,036 children were transferred. There were 3,025 transferred pre-UPTN, while 3,011 were transferred post-establishment. The rate of preventable transfer before the establishment was 36% versus 29% after (p < 0.001). Following the establishment of the UPTN, there was a significant change in the proportion of each injury type that was transferred. A lower percentage of patients had an intracranial bleed (15% vs. 20%, p < 0.001), isolated skull fracture (6.8% vs. 8.8%; p = 0.004), or a blunt solid organ injury (4.3% vs. 5.5%, p = 0.031). There was an increase in the proportion of transferred patients that had an orthopedic injury (36% vs. 28%, p < 0.001) with a significant decrease in PT rate (10% vs. 15%, p = 0.003). In addition, after the UPTN was established, the preventable transfer rate for intracranial bleed significantly decreased from 47% to 37% (p < 0.001). In this study, we found that following the establishment of a trauma network that standardized pediatric trauma guidelines across a region, the rate of preventable transfer decreased. Traumatic brain injuries saw the largest decrease in the proportion of transfers and the rate of preventable transfers. These findings give evidence of trauma networks being a practical tool for decreasing overtriage. Prognostic/Epidemiological; Level III.