“Who is the right patient?” Insights into decisions to transfer pediatric trauma patients

Candy, Sydney; Schuurman, Nadine; Macpherson, Alison; Schoon, Rachel; Rondeau, Kimberly; Yanchar, Natalie

doi:10.1016/j.jpedsurg.2020.01.048

Cited by 4 publications

(2 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Data on ICU LOS and time to definitive care based on 'transfer' status [16,17] are predominantly from the United States [18][19][20][21][22][23][24][25][26], Canada [16,27,28], or Sweden [29], and report contrasting results which have limited generalisability to a UK trauma system due to differences in geography, trauma networks, and triage systems. Similar to the functional outcome analysis, longer hospital and ICU LOS in the 'bypass' groups are likely to be due to the differences in injury burden between the two groups in this study; however, these are comparable with the UK national average [5].…”

Section: Discussionmentioning

confidence: 99%

Paediatric Major Trauma: A Retrospective Observational Comparison of Mortality in Prehospital Bypass and Secondary Transfer in the East of England

Hibberd¹,

Price²,

Laurent³

et al. 2023

Cureus

View full text Add to dashboard Cite

BackgroundMore than half of seriously injured children are not initially treated at a major trauma centre (MTC). Children may be transported by private vehicle to a trauma unit (TU). Children may also be transported by emergency medical services (EMS) to the nearest TU with approximately one in five of these undergoing secondary transfer to an MTC. Most trauma networks permit TU bypass to an MTC. However, the evidence on outcomes between transfer and bypass is limited.This study aimed to evaluate the use of the trauma network by comparing outcomes between paediatric major trauma patients by the method of presentation. MethodsIn this retrospective observational study, a consecutive sample of paediatric (<16 years old) major trauma patients transported to the regional MTC (Cambridge University Hospitals NHS Foundation Trust (CUH)) between 1st January 2015 and 31st December 2020 was included. Patients were excluded if they arrived at the MTC >24 hours post-injury or were transported to the MTC as the nearest hospital. Patients were divided into four groups: self-presented to MTC, MTC as nearest hospital, bypass and secondary transfer. ResultsA total of 315 patients (28 'self-presented', 55 'nearest', 58 'bypass' and 174 'secondary transfers') were included. The median age was 9. 4 [3.7-13.6] years, and n=209 (66.3%) were male. The median Injury Severity Score (ISS) was 16.0 [9.0-25.0] and n=190 (60.3%) had an ISS >15.There was no difference in 30-day mortality between the 'bypass' and 'secondary transfer' groups. There was a significantly longer hospital and intensive care unit length of stay (LOS) in the bypass group compared to other groups, both p<0.001. The median time to definitive care was five hours greater in the secondary transfer group compared to 'bypass' (bypass 117.6 minutes [100.8-136.6], secondary transfer 418.8 minutes [315.6-529.8]). ConclusionThere was no significant difference in 30-day mortality of paediatric major trauma patients who underwent secondary transfer compared to those transported directly from the scene to the MTC, despite significant time delays in reaching definitive care.

show abstract

Section: Discussionmentioning

confidence: 99%

Paediatric Major Trauma: A Retrospective Observational Comparison of Mortality in Prehospital Bypass and Secondary Transfer in the East of England

Hibberd¹,

Price²,

Laurent³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…This systematic review highlights the persistent need for guidelines for transfer of pediatric trauma patients with mild TBI. A study recently published by Candy et al 22 examined providers' decisions to transfer pediatric trauma patients via response to various clinical vignettes at both adult level III trauma centers (TCs) or mixed L3TCs/ PTCs. They found that recommendations to transfer was high for all respondents and that providers at PTCs were significantly more likely to recommend transfer of children than physicians from L3TCs, regardless of GCS, with the discordance decreasing as GCS decreased.…”

Section: Guidelines For Management Of Mild Tbi In Pediatric Populationmentioning

confidence: 99%

Pediatric Mild Traumatic Brain Injury: Who Can Be Managed at a Non-pediatric Trauma Center Hospital? A Systematic Review of the Literature

Keane

Escobar

Neff

et al. 2021

The American Surgeon™

View full text Add to dashboard Cite

Background Pediatric traumatic brain injury (TBI) affects about 475,000 children in the United States annually. Studies from the 1990s showed worse mortality in pediatric TBI patients not transferred to a pediatric trauma center (PTC), but did not examine mild pediatric TBI. Evidence-based guidelines used to identify children with clinically insignificant TBI who do not require head CT were developed by the Pediatric Emergency Care Applied Research Network (PECARN). However, which patients can be safely observed at a non-PTC is not directly addressed. Methods A systematic review of the literature was conducted, focusing on management of pediatric TBI and transfer decisions from 1990 to 2020. Results Pediatric TBI patients make up a great majority of preventable transfers and admissions, and comprise a significant portion of avoidable costs to the health care system. Majority of mild TBI patients admitted to a PTC following transfer do not require ICU care, surgical intervention, or additional imaging. Studies have shown that as high as 83% of mild pediatric TBI patients are discharged within 24 hrs. Conclusions An evidence-based clinical practice algorithm was derived through synthesis of the data reviewed to guide transfer decision. The papers discussed in our systematic review largely concluded that transfer and admission was unnecessary and costly in pediatric patients with mild TBI who met the following criteria: blunt, no concern for NAT, low risk on PECARN assessment, or intermediate risk on PECARN with negative imaging or imaging with either isolated, nondisplaced skull fractures without ICH and/or EDH, or SDH <0.3 cm with no midline shift.

show abstract

Pediatric Trauma—Not Just Little Adults-Part 2: Differences in Radiographic Workup and Management

Greene,

Sandifer,

Shpigel

et al. 2024

Curr Surg Rep

View full text Add to dashboard Cite

“Who is the right patient?” Insights into decisions to transfer pediatric trauma patients

Cited by 4 publications

References 18 publications

Paediatric Major Trauma: A Retrospective Observational Comparison of Mortality in Prehospital Bypass and Secondary Transfer in the East of England

Paediatric Major Trauma: A Retrospective Observational Comparison of Mortality in Prehospital Bypass and Secondary Transfer in the East of England

Pediatric Mild Traumatic Brain Injury: Who Can Be Managed at a Non-pediatric Trauma Center Hospital? A Systematic Review of the Literature

Pediatric Trauma—Not Just Little Adults-Part 2: Differences in Radiographic Workup and Management

Contact Info

Product

Resources

About