Characteristics Of Operative Pediatric Trauma Transfer Patients
Su Yeon Lee1, Jordan E Jackson2, Olivia Vukcevich1, Sarah C Stokes1, Holly Leshikar1, Tanya Rinderknecht1, Shinjiro Hirose1, *Jonathan E Kohler1, Erin G Brown1
1UC Davis, Sacramento, CA;2UCSF East Bay, Oakland, CA
Background: Pediatric trauma centers achieve optimal outcomes in the care of injured children. Many children initially managed at other hospitals require transfer to these centers. However, when children should be transferred remains controversial. We evaluated the characteristics of operative and non-operative pediatric trauma transfer patients to elucidate patterns that could optimize resource utilization for these patients.
Methods: We performed a retrospective review of pediatric trauma patients transferred to a level 1 pediatric trauma center from 2009-2019. Demographic variables, type of operation, and time to operation were evaluated. Patients were categorized by the initial operative subspecialty and compared to non-operative transfers and by timing of operative intervention.
Findings: Of 4,164 transferred patients, 1,413 (33.9%) required operative intervention. Most operations were performed by orthopedic surgery (65.0%), general surgery (11.2%), or neurosurgery (11.0%). Compared to orthopedic surgery transfer patients, general surgery and neurosurgery transfer patients had significantly higher ISS (4 vs. 9 vs. 18, p<0.0001), ICU admission rates (8.9% vs. 41.1% vs. 89.7%, p<0.0001), LOS (2 vs 6 vs 6 days, p<0.0001), and mortality (0.1% vs. 3.8%. vs 5.2%, p<0.0001). Only 41.4% of all operations were performed on day of arrival, with general surgery patients significantly more likely to undergo operation on day of arrival (OR 2.0, CI 1.4-2.8).
Conclusions: One third of pediatric trauma transfer patients required operative intervention, with the majority performed for orthopedic injuries. General surgery and neurosurgical operative transfer patients were more severely injured, with general surgery patients most likely to undergo operative intervention on the day of transfer. Prospective identification of patients with isolated injuries who do not require emergent operation is required to safely utilize a less resource-intensive transfer process than current system.
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