Appropriateness of Pediatric Orthopaedic Transfers to a Level 1 Hospital

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Abstract

Objective:

To compare a cohort of transferred pediatric orthopaedic patients with orthopaedic patients who primarily presented to a Level 1 pediatric emergency department to identify risk factors for transfer.

Design:

Retrospective cohort study.

Setting:

Level 1 trauma center in New York.

Patients:

The cohort consisted of patients younger than 18 years who presented to 1 Level 1 pediatric trauma center between January 1, 2013, and December 31, 2013, with an orthopaedic fracture diagnosis code (ICD-9 805.0-839.9). The control group included the patients who presented to that hospital primarily, and the study group included patients who were transferred to that same hospital from another institution.

Intervention:

Demographic and injury-related data [age, sex, mechanism of injury, location of injury, injury severity score, and insurance status] were collected.

Main Outcome Measurements:

Regression analysis was performed to assess for predictors of transfer to a Level 1 hospital. Subgroup analysis examined whether transfers were appropriate, based on the type of injury.

Results:

There were 1064 patients in the nontransfer group and 67 patients in the transfer group. Transferred patients were more likely to have surgery within 24 hours (39.42% vs. 2.63%) and were more likely to have no insurance or Medicaid (50.75% vs. 33.24%). Injury severity score and insurance status were independent predictors for transfer.

Conclusions:

This study indicates that injury severity is the primary predictor in deciding to transfer a pediatric patient; however, insurance status may play a role in that decision.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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