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. 2023 Jan:281:130-142.
doi: 10.1016/j.jss.2022.08.029. Epub 2022 Aug 30.

Pediatric Injury Transfer Patterns During the COVID-19 Pandemic: An Interrupted time Series Analysis

Katherine T Flynn-O'Brien  1 , Amelia T Collings  2 , Manzur Farazi  3 , Mary E Fallat  4 , Peter C Minneci  5 , K Elizabeth Speck  6 , Kyle Van Arendonk  3 , Katherine J Deans  5 , Richard A Falcone Jr  7 , David S Foley  4 , Jason D Fraser  8 , Samir Gadepalli  6 , Martin S Keller  9 , Meera Kotagal  7 , Matthew P Landman  2 , Charles M Leys  10 , Troy A Markel  2 , Nathan Rubalcava  6 , Shawn D St Peter  8 , Thomas T Sato  3 ; Midwest Pediatric Surgery Consortium
Affiliations

Pediatric Injury Transfer Patterns During the COVID-19 Pandemic: An Interrupted time Series Analysis

Katherine T Flynn-O'Brien et al. J Surg Res. 2023 Jan.

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.

Keywords: Adolescent trauma; COVID-19; Interfacility transfers; Interrupted time series analysis; Pediatric trauma.

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Figures

Fig. 1
Fig. 1
(A) Number of patients transferred and (B) proportion of patients transferred (compared to all trauma patients) to a level I pediatric trauma center over time. Raw values in black. LOESS curve in blue with 95% confidence interval.
Fig. 2
Fig. 2
Interrupted time-series analysis with autoregressive integrated moving average modeling to predict the expected number of transfer patients (solid red), compared to the observed number of transferred patients (black) over time; two-sample Kolmogorov-Smirnov test P < 0.001. Red dashed line represents date of the published Children's Hospital Association's recommendation to transfer pediatric and young adult patients to pediatric centers.
Fig. 3
Fig. 3
Patients discharged home after transfer over time. (A) Number of patients and (B) proportion of transferred patients. Raw values in black. LOESS curve in blue with 95% confidence interval.
See this image and copyright information in PMC

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