Interhospital transfer of pediatric neurosurgical patients

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The purpose of this study was to describe patterns of transfer, resource utilization, and clinical outcomes associated with the interhospital transfer of pediatric neurosurgical patients.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>All consecutive, prospectively collected requests for interhospital patient transfer to the pediatric neurosurgical service at Texas Children's Hospital were retrospectively analyzed from October 2013 to September 2014. Demographic patient information, resource utilization, and outcomes were recorded and compared across predefined strata (low [&lt; 5%], moderate [5%–30%], and high [&gt; 30%]) of predicted probability of mortality using the Pediatric Risk of Mortality score.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Requests for pediatric neurosurgical care comprised 400 (3.7%) of a total of 10,833 calls. Of 400 transfer admissions, 96.5%, 2.8%, and 0.8% were in the low, moderate, and high mortality risk groups, respectively. The median age was 54 months, and 45% were female. The median transit time was 125 minutes. The majority of transfers were after-hours (69.8%); nearly a third occurred during the weekend (32.3%). The median intensive care unit stay for 103 patients was 3 days (range 1–269 days). Median length of hospital stay was 2 days (range 1–269 days). Ninety patients (22.5%) were discharged from the emergency room after transfer. Seventy-seven patients (19.3%) required neurosurgical intervention after transfer, with the majority requiring a cranial procedure (66.2%); 87.3% of patients were discharged home.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>This study highlights patient characteristics, resource utilization, and outcomes among pediatric neurosurgical patients. Opportunities for quality improvement were identified in diagnosing and managing isolated skull fractures and neck pain after trauma.</jats:p></jats:sec>

Evaluating the Role of a Neurosurgery Consultation in Management of Pediatric Isolated Linear Skull Fractures

“…Further evidence that a higher level of care may not be warranted comes from large studies that specifically examined transfers of pediatric ILSF to Level 1 Pediatric Trauma Centers [6, 12, 19, 20]. Similar to these studies, the vast majority of our patients were transfers from outside hospitals.…”

“…Furthermore, a multidisciplinary pediatric trauma clinic is being formed to follow all trauma patients allowing us to collect prospective data following the launch of our new guidelines. Though we recognize the limitations, legal stipulations, and overall comfort of community EDs with managing pediatric head trauma, we agree with existing work that suggests telemedicine may be a solution to minimize transfers and give community hospitals access to specialty services [19, 20, 23-25]. …”

“…Notably, at Texas Children’s Hospital, an ILSF was the most common single diagnosis. Patients with ILSF were also the largest proportion (53.3%) of patients directly discharged-on-transfer [19]. In another study, ILSF represented roughly one quarter of potentially avoidable transfers defined as patients < 18 years who underwent a CT scan prior to transfer and discharged within 1 day of hospital admission without neurosurgical intervention [12].…”

“…Thankfully, the incidence of any neurosurgery intervention in the general pediatric trauma population is small, ranging roughly from 0 to 8% [12-19]. Bonfield et al [13] demonstrated that among 897 pediatric skull fracture patients, only 6.5% underwent surgical repair for fracture elevation, frontal sinus repair, or open fracture debridement for cosmetic reasons.…”

Interregional Centers of High-Tech Children’s Surgery – Mortgage of Accessibility and Quality of Medical Care for Russian Children

“…госпитализаций [38]. Интенсивность целенаправленных межрегиональных перемещений больных и пораженных косвенно свидетельствует о ресурсной обеспеченности сферы национального здравоохранения, наличии отлаженного порядка взаимодействия медицинских организаций различного уровня и дислокации, а также полноте пакета нормативно-правовых документов [39][40][41][42][43][44].…”