Transfer and nontransfer patients in isolated low-grade blunt pediatric solid organ injury: Implications for regionalized trauma systems.

BACKGROUND: Regionalization of trauma care is a national priority and hospitalization for blunt abdominal trauma, which may include transfer, is common among children. The objective of this study was to determine whether there were differences in mortality, treatment, or length of stay between patients treated at or transferred to a higher level trauma center and those not transferred and admitted to a lower level trauma center.

METHODS: Cohort from Washington state trauma registry from 2000 to 2014 of patients 16 years or younger with isolated Grade I-III spleen, liver, or kidney injury.

RESULTS: Among 54,034 patients 16 years or younger, the trauma registry captured 1177 (2.2%) patients with isolated low grade solid organ injuries; 226 (19.2%) presented to a higher level trauma center, 600 (51.0%) presented to a lower level trauma center and stayed there for care, and 351 (29.8%) were transferred to a higher level trauma center. Forty (3.4%) patients underwent an abdominal operation. Among the 950 patients evaluated initially at a lower level trauma center, the risk of surgery did not differ significantly between those who were not transferred compared to those who were (relative risk, 2.19; 95% confidence interval, 0.80-6.01). The risk of total splenectomy was no different for patients who stayed at a lower level trauma center compared with those who were transferred to a higher level trauma center (RR, 0.84; 95% CI, 0.33-2.16). Nontransferred patients had a 0.63 (95% confidence interval, 0.45-0.88) times lower risk of staying in the hospital for an additional day compared with patients who were transferred to a higher level trauma center. One patient died.

CONCLUSION: Few pediatric patients with isolated low grade blunt solid organ injury require intervention and thus may not need to be transferred; trauma systems should revise their transfer policies. Prevention of unnecessary transfers is an opportunity for cost savings in pediatric trauma.

LEVEL OF EVIDENCE: Therapeutic/Care management, level III.