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Factors Associated With the Interfacility Transfer of the Pediatric Trauma Patient: Implications for Prehospital Triage

Ross, David W. DO*; Rewers, Arleta MD, PhD; Homan, Mark B. MPA, NREMT-P*; Schullek, John R. PhD, NREMT-B*; Hawke, Jesse L. PhD; Hedegaard, Holly MD, MSPH

doi: 10.1097/PEC.0b013e318267ea61
Original Articles

Objective The goal of this study was to identify prehospital factors associated with increased likelihood of interfacility transfer of pediatric trauma patients. Such factors might serve as a basis for improvements in future field pediatric trauma triage guidelines.

Methods This was a retrospective cohort study of children aged 12 years or younger with blunt, penetrating, or thermal injuries who were transported by ground emergency medical services from the scene to the emergency department of a Level I, II, or III trauma center within the Denver metropolitan area from January 1, 2000, to December 31, 2008. Characteristics predicting subsequent interfacility transfer to a pediatric trauma center (PTC) were assessed.

Results A total of 1673 patients were included in the analysis. Variables hypothesized to be most commonly associated with interfacility transfer were age, sex, mechanism of injury, body region of injury, and Glasgow Coma Scale score. The cohort included 1079 males and 593 females. Logistic regression analysis yielded the following as significant predictors of transfer: younger age (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.15–1.25), lower Glasgow Coma Scale score (OR, 1.08; 95% CI, 1.01–1.16), the presence of burns (OR, 37.52; 95% CI, 7.3–191.7), non-accidental trauma (OR, 6.09; 95% CI, 2.44–15.25), falls (OR, 1.62; 95% CI, 1.06–2.48), other motor vehicle–related incidents (OR, 2.37; 95% CI, 1.08–5.19), abdominal injury (OR, 5.39; 95% CI, 2.31–12.55), head/neck injury (OR, 7.89; 95% CI, 4.21–14.77), limb injury (OR, 5.31; 95% CI, 2.78–10.16), and multiple injuries (OR, 13.01; 95% CI, 5.0–33.8).

Conclusions Factors highly associated with transfer of an injured child from a non-PTC to a PTC included younger age, burns, non-accidental trauma, head/neck injury, and multiple injuries in younger children. Further investigation is warranted to determine whether these factors may have applicability in future improvements in field pediatric trauma patient triage guidelines.

From the *American Medical Response, Inc, Colorado Springs; and †Department of Pediatrics, Section of Emergency Medicine, University of Colorado Denver; and ‡Colorado Department of Public Health and Environment, Emergency Medical Services and Trauma Section, Denver, CO.

Disclosure: The authors declare no conflict of interest.

Reprints: David Ross, DO, FACEP, American Medical Response Inc, 2370 N. Powers Blvd, Colorado Springs, CO 80915 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.