Background: Timely access to the appropriate level of care, both in the prehospital and in the hospital setting, is necessary to optimize outcomes in severely injured pediatric trauma patients. However, a substantial portion of the pediatric population does not have adequate timely access to a verified Level 1 trauma center. This study aimed to identify significant predictors of in-hospital mortality and transfer to a higher level of care. This is the first statewide analysis that includes pediatric patients who are first seen at nontrauma centers (NTCs).
Methods: Mortality interhospital transfers to a higher level of care were analyzed for the first hospital of care. Clustering was accounted for by generalized estimating equations. p < 0.01 was considered significant.
Results: Younger age was significantly associated with mortality for all patients and with transfer for less severely injured children (Injury Severity Score [ISS] < 15). The odds of mortality in NTCs were lower than in Level 1 trauma centers; however, the majority of NTC patients were transferred, artificially decreasing NTC mortality. The type of trauma (blunt or penetrating) was significantly associated with both mortality and transfer for more severe cases. Although insurance was not significantly associated with transfer, self-pay patients had significantly higher mortality odds.
Conclusion: The NTCs are transferring 98% of their patients, even those with very low ISS and high Glasgow Coma Scale (GCS). Further evaluation of the outcomes and characteristics of patients transferred from NTCs will provide important information to inform the triage guidelines to potentially safely avoid transfer of less severely injured patients from NTCs in their community.
Level of evidence: Therapeutic study, level IV; epidemiologic/prognostic study, level III.