Variations in Pediatric Trauma Transfer Patterns in Northern California Pediatric Trauma Centers (2001–2009)

Abstract

Background: Due to the scarcity of specialized resources for pediatric trauma, "regionalization," or a system designed to get "the right child, to the right place, at the right time," is vital to quality pediatric trauma care. In Northern California, four pediatric trauma centers serve 3.9 million children within a geographically diverse area of 113,630 square miles. A significant proportion of children with trauma is initially triaged to nontrauma hospitals and may require subsequent transfer to a specialty center. Trauma transfer patterns to a pediatric trauma center may provide insight into regional primary triage practices. Transfers from hospitals in close proximity to pediatric trauma centers might suggest that some children could have avoided transfer with minimal additional transport time. While pediatric trauma centers are scarce and serve as regional resources, transfers from beyond the regular catchment area of a trauma center could be an indication of clinical need.Objectives: The objective of this study was to gain an understanding of patterns of pediatric trauma transfer to all pediatric trauma centers within the region as a first step in assessing the efficacy and efficiency of trauma triage. The authors examined three groups of transfer patients: transfers from within the same county as the pediatric trauma center (near transfers), transfers from counties adjacent to the pediatric trauma center (catchment transfers), and transfers from more distant counties (far transfers). The hypothesis was that catchment transfers would form the bulk of transfers, near transfers would compose < 10% of total transfers, and far transfers would be younger and more severely injured than catchment transfers.Methods: This was a retrospective analysis of institutional trauma registry data of children < 18 years from all pediatric trauma centers in Northern California from 2001 through 2009. Transfers were characterized by the location of the transfer hospital relative to the location of the pediatric trauma center. Characteristics associated with near transfer compared to primary triage to a pediatric trauma center were identified, as well as characteristics associated with far transfer compared to catchment transfer.Results: A total of 2,852 of 11,952 (23.9%) pediatric trauma patients were transfers. Near transfers comprised 24.5% of cases, catchment transfers were 37.4%, and far transfers were 38.2%. After controlling for demographic, clinical, and geographic factors, younger age, higher Injury Severity Score (ISS), public versus private insurance, and an injury mechanism of "fall" were associated with near transfer rather than direct triage. Older age, higher ISS, and mechanism of "motor vehicle crash" were associated with far rather than catchment transfer.

Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study

“…Regional trauma networks were one of the first care networks to be developed, and early triage of critically injured patients has been shown to improve trauma outcomes . Accurate risk stratification can be challenging, especially early in the course of illness, so both overtriage and undertriage have been reported . As rural populations age and present with more severe comorbidities, many rural hospitals struggle to coordinate complex trauma care and effect rapid transfer to tertiary centers.…”

Profiling Interfacility Transfers for Hospitalized Pediatric Patients

“…Although pediatric transfers have been studied in certain patient subsets, such as neonates and the critically ill and the injured, interfacility transfers have not been described across all diagnoses nationwide. [1][2][3][4][5][6] Some interfacility transfers occur so patients can access hospitals with specialized care. Such specialty centers include hospitals with NICUs and trauma centers, which have designated levels of care based on complexity of care provided.…”

Interregional Centers of High-Tech Children’s Surgery – Mortgage of Accessibility and Quality of Medical Care for Russian Children

“…ред.) после происшествия [34]. В отечественной практике, данный регламент доступности специализированной медицинской помощи может рассматриваться только применительно к городскому населению.…”

“…В данном регионе, отличающемся значитель-of pediatric surgery, anesthesia and intensive care RUSSIAN JOURNAL 2018 Volume VIII No.3 ным географическим разнообразием, на площади 113130 квадратных миль, проживает 3,9 млн. детей в возрасте до 18 лет, медицинское обеспечение которых возложено на 4 специализированных (травматологических) центра [34]. В связи с отсутствием в данном штате «зрелой» системы регионализации специализированной медицинской помощи детям с различными повреждениями, значительная часть пострадавших первоначально госпитализируется в больницы, не имеющие в структуре травматологических отделений.…”