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Rates and Risk Factors of Inter-Hospital Transfer Among Pediatric Major Trauma Patients in the U.S.
Jin Peng, MD, MS and Huiyun Xiang, MD, MPH, PhD, Nationwide Children's Hospital, Columbus OH

Abstract:
Background: The American College of Surgeon Committee on Trauma (ACS-COT) recommends transferring patients with critical injuries from level III centers to a higher level center. We examined the proportion of pediatric major trauma patients who met the ACS-COT transfer criteria were actually transferred, and identified factors that were associated with transfer status. Methods: We used the 2012 Nationwide Emergency Department Sample (NEDS) data. Eligible patients were those children (age<=16) who met the ACS-COT transfer criteria or had an Injury Severity Score [ISS] larger than 15, excluding those who were initially seen at level I or II centers. We compared patients who were transferred and those who were not transferred. Logistic regression was used to adjust for confounders. Results: We identified 21, 938 eligible patients, representing an estimated 92,335 patients in the U.S. About 13.3% of these patients were transferred to another short-term hospital, and 79.2% were treated and discharged to home. Transfer was less likely for children age 12 to 16 years [odds ratio (OR), 0.53; 95% confidence interval (CI), 0.47-0.59], and for those covered by private medical insurance (OR, 0.57; 95% CI, 0.34-0.95). Transfer was more likely for those children with ISS>15 (OR, 8.76; 95% CI, 7.32-10.48), for those treated at hospitals in the Midwest (OR, 2.06; 95% CI, 1.48-2.86), and for those treated at non-metropolitan hospitals (OR, 2.69; 95% CI, 1.73-4.19). Conclusions: Our findings showed that the transfer rate among pediatric major trauma patients who met ACS-COT transfer criteria was low and argue for further research on the impact of failure to transfer on patient outcomes.
Objective:
At the end of this activity, the learner will be able to discuss the efficiency of pediatric trauma transfer system in the United States
Objective Content: The learner will be able to 1. Assess the inter-hospital transfer rate among pediatric major trauma patients who met the ACS-COT transfer criteria. 2. Identify factors that were associated with transfer status among pediatric major trauma patients.


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