title: Assessment of factors associated with the delayed transfer of pediatric trauma patients: an emergency physician survey.
abstract: OBJECTIVE
  The purpose of this study was to identify, among emergency department (ED) physicians, the potential barriers impacting the appropriate and timely transfer of injured children to pediatric trauma centers.
  
  
  METHODS
  Surveys assessed pediatric trauma knowledge and experience, transfer and imaging decisions, and perceived barriers to patient transfer. Two scenarios were created; one with a child meeting the state trauma triage criteria and one who did not. In April 2010, 936 surveys were mailed to randomly selected ED physicians. Respondents could answer by mail or online until June 30, 2010.
  
  
  RESULTS
  A total of 486 surveys were returned, and 109 were excluded, leaving 377 included in the study. A majority reported limited experience in the care of the critically ill child, with 93%, 99%, 99%, and 100% respectively, having performed less than 5 intubations, intraosseous line, central line, or chest tube placements in the last year. In the scenario in which the child met criteria to be transferred, 74% appropriately transferred the patient, whereas in the other scenario, 34% transferred the patient. As much as 56% of the respondents reported they would perform a head computed tomography before transfer, mainly to avoid missed injuries and medicolegal concerns. Among those who would not transfer either patient, 27% reported not having an on-call surgeon at all times.
  
  
  CONCLUSIONS
  Innovative measures should be developed so that ED physicians gain a greater understanding of the proper identification of pediatric patients requiring a timely transfer to a pediatric trauma center.
authors.affiliation: Trauma Services and †Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Beaudin
authors.forename: Margot
authors.initials: M
authors.lastname: Daugherty
authors.forename: Gary
authors.initials: G
authors.lastname: Geis
authors.forename: Suzanne
authors.initials: S
authors.lastname: Moody
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: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003657:Decision Making; D004636:Emergency Service, Hospital; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014187:Transportation of Patients; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000628:therapy