Faculty Collaboration Database

Pediatric Injury Transfer Patterns During the COVID-19 Pandemic: An Interrupted time Series Analysis. J Surg Res 2023 Jan;281:130-142

Date

09/27/2022

Pubmed ID

36155270

Pubmed Central ID

PMC9424522

DOI

10.1016/j.jss.2022.08.029

Scopus ID

2-s2.0-85138501313 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

INTRODUCTION: With the expected surge of adult patients with COVID-19, the Children's Hospital Association recommended a tiered approach to divert children to pediatric centers. Our objective was understanding changes in interfacility transfer to Pediatric Trauma Centers (PTCs) during the first 6 mo of the pandemic.

METHODS: Children aged < 18 y injured between January 1, 2016 and September 30, 2020, who met National Trauma Databank inclusion criteria from 9 PTCs were included. An interrupted time-series analysis was used to estimate an expected number of transferred patients compared to observed volume. The "COVID" cohort was compared to a historical cohort (historical average [HA]), using an average across 2016-2019. Site-based differences in transfer volume, demographics, injury characteristics, and hospital-based outcomes were compared between cohorts.

RESULTS: Twenty seven thousand thirty one/47,382 injured patients (57.05%) were transferred to a participating PTC during the study period. Of the COVID cohort, 65.4% (4620/7067) were transferred, compared to 55.7% (3281/5888) of the HA (P < 0.001). There was a decrease in 15-y-old to 17-y-old patients (10.43% COVID versus 12.64% HA, P = 0.003). More patients in the COVID cohort had injury severity scores ≤ 15 (93.25% COVID versus 87.63% HA, P < 0.001). More patients were discharged home after transfer (31.80% COVID versus 21.83% HA, P < 0.001).

CONCLUSIONS: Transferred trauma patients to Level I PTC increased during the COVID-19 pandemic. The proportion of transferred patients discharged from emergency departments increased. Pediatric trauma transfers may be a surrogate for referring emergency department capacity and resources and a measure of pediatric trauma triage capability.

Author List

Flynn-O'Brien KT, Collings AT, Farazi M, Fallat ME, Minneci PC, Speck KE, Van Arendonk K, Deans KJ, Falcone RA Jr, Foley DS, Fraser JD, Gadepalli S, Keller MS, Kotagal M, Landman MP, Leys CM, Markel TA, Rubalcava N, St Peter SD, Sato TT, Midwest Pediatric Surgery Consortium

Authors

Manzur Rahman Farazi Statistical Research Scientist II in the Institute for Health and Equity department at Medical College of Wisconsin
Katherine T. Flynn-O'Brien MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Child
Humans
Injury Severity Score
Interrupted Time Series Analysis
Pandemics
Patient Transfer
Retrospective Studies
Trauma Centers
Wounds and Injuries