Transfer and Non-Transfer Patients in Isolated Low-Grade Blunt Pediatric Solid Organ Injury: Implications for Regionalized Trauma Systems

ABSTRACT:BackgroundRegionalization of trauma care is a national priority and hospitalization for blunt abdominal trauma, that may include transfer, is common among children. The objective of this study was to determine whether there were differences in mortality, treatment, or length of stay between patients treated at or transferred to a higher level trauma center and those not transferred and admitted to a lower level trauma center.MethodsCohort from Washington state trauma registry from 2000-2014 of patients 16 years or younger with isolated Grade I-III spleen, liver, or kidney injury.ResultsAmong 54034 patients 16 years or younger, the trauma registry captured 1177 (2.2 %) patients with isolated low grade solid organ injuries; 226 (19.2%) presented to a higher level trauma center, 600 (51.0%) presented to a lower level trauma center and stayed there for care, and 351 (29.8%) were transferred to a higher level trauma center. Forty patients (3.4%) underwent an abdominal operation. Among the 950 patients evaluated initially at a lower level trauma center, the risk of surgery did not differ significantly between those who were not transferred compared to those who were (RR 2.19 95%CI 0.80-6.01). The risk of total splenectomy was no different for patients who stayed at a lower level trauma center compared to those who were transferred to a higher level trauma center (RR 0.84 95%CI 0.33-2.16). Non-transferred patients had a 0.63 (95% CI: 0.45-0.88) times lower risk of staying in the hospital for an additional day compared to patients who were transferred to a higher level trauma center. One patient died.ConclusionFew pediatric patients with isolated low grade blunt solid organ injury require intervention and thus may not need to be transferred; trauma systems should revise their transfer policies. Prevention of unnecessary transfers is an opportunity for cost savings in pediatric trauma.Level of EvidenceIII, Epidemiological Background Regionalization of trauma care is a national priority and hospitalization for blunt abdominal trauma, that may include transfer, is common among children. The objective of this study was to determine whether there were differences in mortality, treatment, or length of stay between patients treated at or transferred to a higher level trauma center and those not transferred and admitted to a lower level trauma center. Methods Cohort from Washington state trauma registry from 2000-2014 of patients 16 years or younger with isolated Grade I-III spleen, liver, or kidney injury. Results Among 54034 patients 16 years or younger, the trauma registry captured 1177 (2.2 %) patients with isolated low grade solid organ injuries; 226 (19.2%) presented to a higher level trauma center, 600 (51.0%) presented to a lower level trauma center and stayed there for care, and 351 (29.8%) were transferred to a higher level trauma center. Forty patients (3.4%) underwent an abdominal operation. Among the 950 patients evaluated initially at a lower level trauma center, the risk of surgery did not differ significantly between those who were not transferred compared to those who were (RR 2.19 95%CI 0.80-6.01). The risk of total splenectomy was no different for patients who stayed at a lower level trauma center compared to those who were transferred to a higher level trauma center (RR 0.84 95%CI 0.33-2.16). Non-transferred patients had a 0.63 (95% CI: 0.45-0.88) times lower risk of staying in the hospital for an additional day compared to patients who were transferred to a higher level trauma center. One patient died. Conclusion Few pediatric patients with isolated low grade blunt solid organ injury require intervention and thus may not need to be transferred; trauma systems should revise their transfer policies. Prevention of unnecessary transfers is an opportunity for cost savings in pediatric trauma. Level of Evidence III, Epidemiological There are no conflicts of interest, financial or otherwise. Meeting Presentation: Innovations in Injury Prevention Science, Society for Advancement of Violence and Injury Research, September 18-20, 2017 in Ann Arbor, Michigan This study was supported by grant 5 T32 HD057822-08 from NICHD © 2017 Lippincott Williams & Wilkins, Inc.

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