title: The impact of transfer on pediatric trauma outcomes.
abstract: BACKGROUND
  Recently, concerns have been raised over delays that result from transferring patients to designated trauma centers. This study aimed to assess whether transfer status had an impact on pediatric trauma outcomes.
  
  
  METHODS
  Using a local 1996-2014 pediatric trauma database containing 1541 patients, the following outcomes were tested: death, major complication, time to definitive treatment (TDT), hospital length of stay (LOS), and ICU length of stay (ICU LOS). Logistic, generalized linear, and Poisson regression models were used.
  
  
  RESULTS
  Mortality and complication rates did not differ significantly between direct (mortality=52/1000, complications=54/1000) and transferred (mortality=59/1000; complications=67/1000) patients (mortality aRR: 1.17, 95% CI: 0.76-1.80, p=0.48; complication aRR: 1.13, 95% CI: 0.75-1.70, p=0.57). Transfer status was not a significant predictor of ICU LOS (p=0.72). Transfer status was a significant predictor of time to definitive treatment (transfer x-=17.4h vs. direct x-=2.6h, p=0.0035) and of LOS for severely injured patients (p=0.005). The significant predictors of pediatric trauma mortality were: ISS, transport mode, age, and TDT, and of major complication were ISS and TDT.
  
  
  CONCLUSIONS
  Although transferred patients had longer time to specialized care, there were no significant differences in the mortality or complication rates between transferred and direct patients after adjusting for injury severity.
authors.affiliation: University of Ottawa Medical School, 451 Smyth Road, Ottawa, Ontario, Canada K1H 8M5; Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8MS. Electronic address: tlock016@uottawa.ca.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Locke
authors.affiliation: University of Ottawa, Division of General Surgery, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. Electronic address: janellerekman@gmail.com.
authors.forename: Janelle
authors.initials: J
authors.lastname: Rekman
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8MS.
authors.forename: Maureen
authors.initials: M
authors.lastname: Brennan
authors.affiliation: University of Ottawa Medical School, 451 Smyth Road, Ottawa, Ontario, Canada K1H 8M5; Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8MS. Electronic address: anasr@cheo.on.ca.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards*; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*
keywords: Injury severity score; Mortality; Multiple trauma; Patient transfer; Pediatrics; Trauma centers