Independent predictive factors for an early interhospital transfer (<48h) of severely injured pediatric trauma patients to superordinate trauma centers in Germany: An Analysis from the TraumaRegister DGU®

Abstract

Abstract Background Particularly for pediatric trauma patients, it is of utmost importance that the right patient be treated in the right place at the right time. While unnecessary interhospital transfers must be avoided, the decision against transfer should not lead to higher complication rates in trauma centers without added pediatric qualifications. Therefore, we aimed to identify independent predictors for an early interhospital transfer and analyzed the mortality of non-transferred patients, adjusted for several confounders. Furthermore, we evaluated the implementation of transfer recommendations of the Whitebook Medical Care of the Severely Injured of the German Trauma Society. Methods A national dataset from the TraumaRegister DGU® was used to retrospectively identify factors for an early interhospital transfer (< 48h) to a superordinate trauma center. Severely injured pediatric patients (age < 16 years) admitted between 2010–2019 were included in this analysis. Adjusted odds ratios (OR) with 95% confidence intervals (CI) for early transfer were calculated from a multivariable model. Prognostic factors for hospital mortality in non-transferred patients were also analyzed. Results In total, 6,069 severely injured children were included. Of these, 65.2% were admitted to a Level I trauma center, whereas 27.7% and 7.1% were admitted to Level II and III centers, respectively. After the initial evaluation in the emergency department, 25.5% and 50.1% of children primarily admitted to a Level II or III trauma center, respectively, were transferred early. Statistically significant predictors of an early transfer were: Severe traumatic brain injury (OR 1.76, CI 1.28-2.43). Injury severity score (ISS) ≥ 16 points (OR for each ISS category > 2.0). Age < 10 years (OR for each age category < 10 years of age > 1.62). Admission to a Level III trauma center (OR 3.80, CI 2.95-4.90). The most important independent factor for mortality in non-transferred patients was age < 10 years (OR = 1.70). Conclusions Knowing the independent predictors for an early transfer, such as a young patient's age, a high injury severity, severe traumatic brain injury, and Level III admission, may improve the choice of the appropriate trauma center. This may guide the rapid decision for an early interhospital transfer. There is still a lack of outcome data on children with early interhospital transfers in Germany, who are the most vulnerable group. The latest German guideline recommendations for interhospital transfers were reliably implemented.