title: Preventable transfers in pediatric trauma: A 10-year experience at a level I pediatric trauma center.
abstract: BACKGROUND
  Injured children are often treated at one facility then transferred to another that specializes in pediatric trauma care. The purpose of this study was to identify and characterize potentially preventable transfers (PT) to a freestanding level-I pediatric trauma center.
  
  
  METHODS
  Children with traumatic injuries transferred between 2003 and 2013 were retrospectively analyzed. A PT was defined as a child who was discharged within 36hours of arrival without surgical intervention or advanced imaging studies.
  
  
  RESULTS
  During this period, 6380 children were transferred, with head injury being the most common injury. 61% had CT imaging performed before transfer. The mean age was 6.9years, mean injury severity score (ISS) 10.4, and median transfer distance 37miles. 27% of these transfers were classified as PT. Air transport was used in 15% at mean charge of $18,574. 29% were discharged from the emergency department. When compared, PTs were younger (6.0 vs. 7.2years, p<0.001), with lower median ISS (5 vs. 9, p<0.001), shorter median LOS (15 vs. 43.6hours, p<0.001), and less PICU admissions (6% vs. 34%, p<0.001).
  
  
  CONCLUSIONS
  A significant number of pediatric trauma transfers can be classified as preventable. Reducing preventable transfers could offer opportunities for improving value in a trauma care system.
authors.affiliation: Division of Pediatric Surgery, University of Utah School of Medicine, Primary, Children's Hospital, Salt Lake City, UT, United States. Electronic address: stephen.fenton@hsc.utah.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Fenton
authors.affiliation: Division of Pediatric Surgery, University of Utah School of Medicine, Primary, Children's Hospital, Salt Lake City, UT, United States. Electronic address: justin.lee@hsc.utah.edu.
authors.forename: Justin H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Division of Pediatric Surgery, University of Utah School of Medicine, Primary, Children's Hospital, Salt Lake City, UT, United States. Electronic address: austin.stevens@hsc.utah.edu.
authors.forename: Austin M
authors.initials: AM
authors.lastname: Stevens
authors.affiliation: University of Utah School of Medicine, Salt Lake City, UT, United States. Electronic address: kyle.kimbal@hsc.utah.edu.
authors.forename: Kyle C
authors.initials: KC
authors.lastname: Kimbal
authors.affiliation: Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States. Electronic address: chong.zhang@hsc.utah.edu.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States. Electronic address: angela.presson@hsc.utah.edu.
authors.forename: Angela P
authors.initials: AP
authors.lastname: Presson
authors.affiliation: Division of Pediatric Surgery, University of Utah School of Medicine, Primary, Children's Hospital, Salt Lake City, UT, United States. Electronic address: metzger2020@gmail.com.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Metzger
authors.affiliation: Division of Pediatric Surgery, University of Utah School of Medicine, Primary, Children's Hospital, Salt Lake City, UT, United States. Electronic address: eric.scaife@hsc.utah.edu.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Scaife
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control* / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014589:Utah; D014947:Wounds and Injuries / Q000145:classification / Q000628:therapy*
keywords: Interfacility transfer; Pediatric; Trauma