Analysis of Preventable Transfers of Pediatric Trauma Patients From Montana to an out of State Tertiary Level I Pediatric Trauma Center

Abstract

Background

The process of transferring pediatric trauma patients to specialized centers is essential for providing high-level trauma care to critically injured children. However, preventing unnecessary transfers is also a crucial component of optimizing healthcare utilization. The aim of this study was to identify and describe patients who underwent preventable transfers from hospitals in Montana to a single out-of-state Level I Pediatric Trauma Center (PTC).

Methods

We performed a retrospective review of pediatric trauma patients who underwent transfer from hospitals in Montana to an out-of-state Level I PTC from 2013 to 2022. Our primary outcome, preventable transfer, was defined as discharge within 48 h without advanced imaging (CT or MRI) or surgical intervention. We performed a secondary analysis to identify possibly preventable transfers (i.e. patients that could have been safely managed at an in-state Level II Adult Trauma Center).

Results

Out of 132 total patients, 22 patients (16 %) met criteria for preventable transfer and 31 patients (23 %) met criteria for possibly preventable transfer.

The majority of preventable transfers involved head trauma (68 %), followed by isolated orthopedic injuries (18 %), and burns (9 %). The majority of the possibly preventable transfers involved head trauma (48 %), followed by orthopedic injuries (16 %).

The average distance travelled was 466 miles (SD: 110 miles) for preventable transfers and 458 miles (SD: 81 miles) for possibly preventable transfers.

Conclusions

A significant proportion of pediatric trauma patients in Montana who underwent long-distance transfer to an out-of-state Level I PTC likely could have received appropriate care at facilities closer to home.

Level of evidence

IV, Prognostic and Epidemiological.