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Computed Tomography Scans Prior to Transfer to a Pediatric Trauma Center: Effects on Transfer Time, Resource Use, and Outcomes
Christopher Snyder, MD, MSPH; Paul Danielson, MD; Raquel Gonzalez, MD; Nicole Chandler, MD
Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL

BACKGROUND
Injured children frequently undergo computed tomography (CT) scans at referring facilities prior to transfer to a pediatric trauma center (PTC). The impact of pre-transfer CT on transfer time and outcomes is not well defined. Many patients with Glasgow Coma Scale (GCS) of 15 undergo pre-transfer head CT to evaluate for injury requiring urgent intervention, but the necessity of this practice is unclear.

METHODS
All trauma patients transferred in to a single freestanding PTC from 2009-2017 were included and categorized by undergoing pre-transfer CT or not. Transfer time (referring hospital arrival to PTC arrival), hospital length of stay (LOS), and mortality were compared. Multivariable modeling was used to adjust for covariates. Patients who had pre-transfer GCS 15 were evaluated for frequency of pre-transfer head CT and urgent neurosurgical intervention within 6 hours of arrival at PTC.

RESULTS
Of 4177 transfer patients, 1795 (43%) underwent pre-transfer CT (29% head CT alone, 14% other/multiple CT). Transfer times were significantly longer for patients who underwent pre-transfer CT (285 vs. 259 minutes, p<0.0001) after adjustment for age, injury severity, transfer distance, and air/ground transport. There were no significant differences in LOS or mortality. Among 3437 patients with pre-transfer GCS 15, 1208 (35%) underwent pre-transfer head CT and 13 (0.4%) required urgent neurosurgical intervention.

CONCLUSIONS
Pre-transfer CT was associated with delays in transfer to definitive care. Among patients with pre-transfer GCS 15, the risk of urgent neurosurgical intervention was very low. Referring facilities and PTCs should develop shared protocols for appropriate use of pre-transfer CT.


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