Unnecessary Imaging, Not Hospital Distance, or Transportation Mode Impacts Delays in the Transfer of Injured Children

Abstract

Despite the advantages of care in trauma centers, a significant number of severely injured children are transferred well beyond 2 hours after injury. This study has demonstrated that this pattern of delayed transfer is a systemic problem occurring among all transferring hospitals regardless of distance or mode of patient transfer and is associated with increased use of imaging before transfer.

Imaging before transfer to designated pediatric trauma centers exposes children to excess radiation

“…This imaging is often either unnecessary, according to the Advanced Trauma Life Support (ATLS) recommendations indicating that scans should not be performed at OH when a child is to be transferred for treatment, and not performed at all without clinical indications. These scans then result in delayed care (3)(4)(5), excessive radiation exposure (3,6), and increased healthcare costs (6).…”

Is paediatric trauma severity overestimated at triage? An observational follow-up study

“…Local hospitals have an important role in treating and stabilising patients, but critical time can be spent on unnecessary examinations or procedures, thus delaying definitive care. 9,27 This emphasises the importance of accurate identification of patients in need of direct transport to the TC, in contrast to those who in fact might benefit from stabilisation at a local hospital prior to transfer. 26,28,29 Thus, other circumstances may influence the EMS providers' choice of receiving facility, including, for instance, patient characteristics and local availability of specialised resources, 30 particularly paediatric and/or surgical capacity.…”

Role of Computed Tomography and Clinical Findings in Pediatric Blunt Intestinal Injury

“…Consistent with other reports, the likelihood of a child having a repeated CT scan was significantly higher if the original scan was performed before arrival at a pediatric institution. 10,11 Unfortunately, because of the retrospective nature of the database, the decision making concerning the reason for repeating these scans is not available. Still, advanced trauma life support guidelines state that patients do not require a workup with CT scans at the initial hospital if transfer to a trauma is likely.…”

“…Unfortunately however, such imaging has been associated with delays in transfer and is often either deemed unnecessary or needed to be repeated secondary to poor image quality or the images being misplaced on transfer. 10,11 In the current study, 119 patients (41%) obtained their initial CT before being transferred to the pediatric trauma center. Consistent with other reports, the likelihood of a child having a repeated CT scan was significantly higher if the original scan was performed before arrival at a pediatric institution.…”