O0805 Oct.3: 1:52pm - Referral of Pediatric Patients with Isolated Fractures to a Tertiary Children's Hospital Who Did Not Require Emergent Intervention

Background: Pediatric orthopedic injuries are a common reason to transfer a patient to a pediatric emergency department (ED) from another healthcare facility. Studies have shown that children with orthopedic injuries who are transferred to tertiary children’s hospitals are often managed without any acute interventions, resulting in additional costs and utilization of resources. No studies to date have looked at which injury patterns result in interfacility transfers in pediatric patients in which there is no acute intervention. The aim of this study was to identify pediatric injury patterns that result in unnecessary transfer so that protocols for the management of common orthopedic injuries can be developed in order to reduce interfacility transfers that do not result in orthopedic intervention.

Methods: We performed a retrospective review of patients transferred from another healthcare facility to a tertiary children’s hospital with orthopedic fractures between October 2013 to September 2018. We determined which patients underwent intervention for their fractures defined a priori as immediate operative intervention, hospital admission, and/or fracture reduction in the ED. We excluded patients with complex medical conditions, those transferred for a child abuse evaluation, and patients that underwent trauma activations. Chart review was then performed for those patients who did not undergo intervention to record patient characteristics, transfer properties (location transferred from, time of transfer, insurance status) and fracture type. Statistical analysis was performed using Stata-SE© software.

Results: Over the study period, 1525 pediatric patients were transferred to a tertiary children’s hospital with a diagnosis of fracture; 846 from another ED, 544 from an urgent care, 47 from radiology, and 88 from another clinic. Of those patients, 191 (12.5%) had no intervention performed at the children’s hospital. A higher proportion of patient transfers from urgent care (99/544, 18.2%), radiology (28/47, 59.6%), and outpatient clinics (24/88, 27.3%) received no intervention when compared to transfers from another emergency department (40/846, 4.7%, p<0.05). Of patients who were transferred and did not receive an intervention, the most common fracture types were proximal humerus fracture (28/191, 14.7%) and type 1 supracondylar fracture (14/191, 7.3%). Of the 191 patients who did not require intervention after transfer, orthopedic surgery was consulted in 152 (79.6%) cases and 12 patients (6.3%) ultimately required an outpatient surgery within one week.

Conclusion: 12.5% of transfers to a tertiary children’s hospital did not ultimately require intervention. Transfers from urgent care, clinic, and the radiology department were more likely to be managed without acute intervention when compared to transfers from another emergency department. Findings from this study could help with creating protocols for the management of common pediatric fractures that rarely require acute intervention (such as proximal humerus fractures and supracondylar fractures) which could help reduce unnecessary transfers.