The influence of age on transfer of pediatric trauma patients after initial transport to hospitals with a higher capacity for general emergency care

Abstract

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective:The aim of this study was to investigate factors associated with the decision to transfer, rather than admit, pediatric trauma patients who were initially transported to emergency departments with a high capacity for general emergency care (regional emergency centers, RECs). Methods: In this retrospective analysis of the 2014 emergency medical services (EMS) sample of injured pediatric patients, we included injured patients below 19 years of age who were transported by EMS to an REC. The main exposure variable was age, which was categorized into four groups by 5-year intervals. The primary outcome was the emergency department (ED) disposition of the patients (admission versus transfer). A multivariable logistic regression analysis was conducted to estimate the effect of age group on ED disposition. Results: Data from 2,031 patients were analyzed. The transfer rate was 49.5%. In a univariate analysis, no statistically significant associations were found between severity or age group and ED disposition (19.9% vs. 18.6%, P=0.76; 20.1% vs. 16.8%, P=0.49; respectively). After adjusting for potential covariates, age group had a significant effect on transfer. When compared to 15-19 years old, the younger age groups had higher adjusted odds ratios (aORs) for transfer (0-4 years old, aOR 7.65 [95% CI, 1.24 to 47.38]; 5-9 years old, aOR 14.48 [95% CI, 2.08 to 100.55]; 10-14 years old, aOR 5.03 [95% CI, 10.5 to 26.79]). Conclusion: Younger pediatric patients with moderate to severe trauma are more likely to be transferred to another hospital despite initial transportation to a REC.