Association of Initiation of Statewide Pediatric Trauma Collaborative and Hospital Preventable Transfer Rates

Jack H Scaife; Christopher E Clinker; Abigail J Alexander; Stephanie E Iantorno; R Scott Eldredge; Robert A Swendiman; Stephen J Fenton; Katie W Russell

doi:10.1016/j.jpedsurg.2024.162004

Association of Initiation of Statewide Pediatric Trauma Collaborative and Hospital Preventable Transfer Rates

J Pediatr Surg. 2024 Oct 26:162004. doi: 10.1016/j.jpedsurg.2024.162004. Online ahead of print.

Authors

Jack H Scaife¹, Christopher E Clinker², Abigail J Alexander², Stephanie E Iantorno², R Scott Eldredge³, Robert A Swendiman², Stephen J Fenton², Katie W Russell²

Affiliations

¹ Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: katie.russell@hsc.utah.edu.
² Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
³ Mayo Clinic, Department of Surgery, Phoenix, AZ, USA; Phoenix Children's Hospital, Phoenix, AZ, USA.

PMID: 39489683
DOI: 10.1016/j.jpedsurg.2024.162004

Abstract

Introduction: The Utah Pediatric Trauma Network (UPTN), established in 2019, is a collaboration of hospitals that have implemented guidelines to optimize pediatric trauma care. The purpose of this study was to determine whether preventable transfer (PT) rates decreased following the establishment of the UTPN and what hospital characteristics were associated with decreased preventable transfers.

Methods: Children with traumatic injuries transferred from hospitals in the UPTN to the state's only Level I Pediatric Trauma Center between 2013 and 2023 were retrospectively analyzed. A PT was a child discharged within 48 h of arrival without surgical intervention or advanced imaging studies. The main hospital-level outcome measure was an overall decrease in PT after the UPTN establishment in 2019.

Results: After 2019, 34 of the 46 hospitals meeting inclusion criteria saw a decrease in the percentage of PTs, while 12 saw an increase in PT rate, with an overall median change of -7 % (IQR -14 %, 0 %). We observed that hospitals with decreased PT had higher rates of PT before the establishment of the UPTN and had higher overall transfer volume than hospitals without a decreased PT rate. Can we put the overall p value in this?

Conclusion: Most hospitals were able to successfully decrease PT rates following the creation of the UPTN. More smaller hospitals did not successfully decrease PT, so more work may need to be done to target lower-volume hospitals.

Keywords: Overtriage; Pediatric trauma; Secondary triage; Trauma network.