A comprehensive review of trauma transfers to a rural pediatric trauma center.

Abstract

The purpose of this study is to delineate transfer patterns to a rural Level 2 pediatric trauma center by identifying common diagnoses associated with potentially avoidable transfers (PAT) to a higher level of care with the end goal of optimizing resource utilization in the center's catchment area. Using trauma registry data, every pediatric trauma patient (< 15 years old) transferred to our Level 2 trauma center from January 2017 to December 2023, was included. "Potentially avoidable transfer" was characterized as a patient who, upon arriving at the trauma center, did not undergo any testing or intervention and was discharged after 0 or 1 midnights. Statistical analysis was performed to better characterize features associated with PAT. 890 patients met inclusion criteria, of which 93 were identified as PAT (10%). The mechanism of injury most likely to result in a PAT was a fall. PATs were more likely to have had CT imaging performed prior to transfer. No injury, as well as head injuries confined to concussions, or skull fracture without hemorrhage were associated with PAT, while chest, long bone fractures, and abdominal injuries were associated with unavoidable transfer (UAT). Analysis of transfer patterns in this study reveals consistent diagnoses associated with potentially avoidable transfers and highlights areas for enhanced education and collaboration with critical access hospitals. It also indicates a possible need to re-address recommendations to referring centers in terms of CT imaging prior to transfer.