Unnecessary imaging, not hospital distance, or transportation mode impacts delays in the transfer of injured children.
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.
Chatoorgoon
Kaveer
K
Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Huezo
Karen
K
Rangel
Erika
E
François
Nathaly
N
Schweer
Lynn
L
Daugherty
Margot
M
Koehn
Margie
M
Ricketts
Crystal
C
Brown
Rebeccah L
RL
Garcia
Victor F
VF
Falcone
Richard A
RA
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*