top of page

Topic:

​

Issue:

​

Category:

​

Title:

Inappropriate Pediatric Orthopaedic Emergency Department Transfers: A Burden on the Health Care System

Author:

Cao, Lisa A. MD; Hull, Brandon MD; Elliott, Marilyn MS; Orellana, Kevin J. BS; Schell, Benjamin MD; Riccio, Anthony I. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

April 2024

Reference:

44(4):p 221-224, DOI: 10.1097/BPO.0000000000002623

Level Of Evidence:

III

# of Patients:

437

Study Type:

Retrospective cohort study

Location:

Large metropolitan level 1 pediatric trauma center

Summary:

The study assessed the appropriateness of transfers for pediatric orthopedic injuries to a level 1 pediatric trauma center. It identified factors associated with inappropriate transfers and evaluated the burden placed on health care systems by unnecessary transfers.

Methods:

Retrospective review of medical records from 6 years. Inclusion: Transfers for isolated orthopedic injuries. Data points included demographics, injury details, insurance status, transfer timing, and orthopedic on-call coverage at referring facilities. Transfers were deemed appropriate if patients required sedated reduction, hospital admission, or surgery within 24 hours.

Exclusions:

Transfers not related to orthopedic injuries or those lacking sufficient follow-up data.

Results:

Inappropriate Transfers: 26% of transfers were unnecessary. Non-white patients had a higher rate of inappropriate transfers (34.01% vs. 21.58%, P=0.009). Facilities with orthopedic on-call coverage had more inappropriate transfers (26.6% vs. 23.4%, P<0.001). Timing of transfer and insurance status did not influence appropriateness.

Conclusions:

A significant portion of pediatric orthopedic transfers are unnecessary, straining health care resources and burdening families. Efforts to improve emergency provider education and enhance decision-making may reduce inappropriate transfers and optimize resource utilization.

Relevance:

Limitations:

Perspective:

bottom of page