The association of insurance status on the probability of transfer for pediatric trauma patients.
OBJECTIVE
The purpose of this study was to evaluate the association of insurance status on the probability of transfer of pediatric trauma patients to level I/II centers after initial evaluation at lower level centers.


METHODS
A retrospective review of all pediatric trauma patients (age<16years) registered in the 2007-2012 National Trauma Data Bank was performed. Multiple regression techniques controlling for clustering at the hospital level were used to determine the impact of insurance status on the probability of transfer to level I/II trauma centers.


RESULTS
Of 38,205 patients, 33% of patients (12,432) were transferred from lower level centers to level I/II trauma centers. Adjusting for demographics and injury characteristics, children with no insurance had a higher likelihood of transfer than children with private insurance. Children with public or unknown insurance status were no more likely to be transferred than privately insured children. There were no variable interactions with insurance status.


CONCLUSIONS
Among pediatric trauma patients, lack of insurance is an independent predictor for transfer to a major trauma center. While burns, severely injured, and younger patients remain the most likely to be transferred, these findings suggest a triage bias influenced by insurance status. Additional policies may be needed to avoid unnecessary transfer of uninsured pediatric trauma patients.


METHODS
Case-control study, level III.
Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
Emma C
EC
Hamilton
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
Charles C
CC
Miller
Department of Surgery and Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
Bryan A
BA
Cotton
Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX.
Charles
C
Cox
Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
Lillian S
LS
Kao
Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX; Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX; Department of Pediatric Patient Care, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: MAustin@mdanderson.org.
Mary T
MT
Austin
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data*; D011336:Probability; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics / Q000706:statistics & numerical data*; D014218:Triage / Q000191:economics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000191:economics / Q000628:therapy*
Health disparity; Insurance; Pediatric trauma; Race; Transfer