title: Unnecessary imaging, not hospital distance, or transportation mode impacts delays in the transfer of injured children.
abstract: OBJECTIVE
  Timely transfer of injured children to pediatric trauma centers (PTCs) that can address their unique needs is important. This study was designed to understand the characteristics of transferred injured children.
  
  
  METHODS
  Data from our level I PTC over 5 years (2002-2006) were reviewed. Transferred patients were divided based on time from injury to arrival at our PTC: early (<2 hours) and late (>2 hours). Data collected included demographics, Injury Severity Scale score, Glasgow Coma Scale score, mode of transportation, referring hospital information including pretransfer imaging, and disposition from our emergency room.
  
  
  RESULTS
  Seven hundred forty-eight patients were included. Eighty-two percent (n = 612) were in the late group and arrived, on average, 6 hours after those transferred early (420 vs 69.9 minutes, P < 0.05). Seventy-nine percent (n = 147) of transfers with severe injuries (Injury Severity Scale score >15) and 47% (n = 15) of those with severe head injuries (Glasgow Coma Scale score <8) arrived late. The disproportionate number of late transfers was consistent among all transferring hospitals regardless of distance and only slightly improved in the group transferred by air ambulance. In addition, those transferred late had significantly more pretransfer imaging (49% vs 23%, P = 0.0025).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Kaveer
authors.initials: K
authors.lastname: Chatoorgoon
authors.forename: Karen
authors.initials: K
authors.lastname: Huezo
authors.forename: Erika
authors.initials: E
authors.lastname: Rangel
authors.forename: Nathaly
authors.initials: N
authors.lastname: François
authors.forename: Lynn
authors.initials: L
authors.lastname: Schweer
authors.forename: Margot
authors.initials: M
authors.lastname: Daugherty
authors.forename: Margie
authors.initials: M
authors.lastname: Koehn
authors.forename: Crystal
authors.initials: C
authors.lastname: Ricketts
authors.forename: Rebeccah L
authors.initials: RL
authors.lastname: Brown
authors.forename: Victor F
authors.initials: VF
authors.lastname: Garcia
authors.forename: Richard A
authors.initials: RA
authors.lastname: Falcone
mesh_terms: D017732:Air Ambulances; D000552:Ambulances; D002648:Child; D005260:Female; D015600:Glasgow Coma Scale; D006297:Health Services Accessibility; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009820:Ohio; D010360:Patient Transfer; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000628:therapy*