Lyria Hoa Min Hui, Ong Yong-Kwang Gene, Pek Jen Heng
Department of Emergency Medicine, Sengkang General Hospital, Singapore.
Department of Children's Emergency, KK Women's and Children's Hospital, Singapore.
Turk J Emerg Med. 2020 Jan 28;20(1):12-17. doi: 10.4103/2452-2473.276379. eCollection 2020 Jan-Mar.
Pediatric trauma patients presenting to general emergency departments (EDs) may be transferred to pediatric EDs for further management. Unnecessary transfers increase health-care costs, add to workload, and decrease satisfaction. We, therefore, aimed to evaluate the proportion of unnecessary pediatric trauma transfers and describe patient characteristics of these transfers at the pediatric ED.
A retrospective chart review of cases with trauma-related diagnoses was carried out from January to April 2017. Information regarding patient demographics, diagnosis, and clinical progress was collected. A transfer was defined as unnecessary if the patient was discharged from the pediatric ED without any therapeutic procedure performed.
There were 117 cases of trauma transfers. The mean age was 8.3 ± 4.9 years, and 77 (65.8%) patients were male. Ninety-five (81.2%) transfers were from restructured hospitals. Thirty-one (26.5%) cases were admitted to the hospital. Thirty-four (29.1%) cases were unnecessary transfers. The length of stay in the ED for these transferred cases was 118.4 ± 87.1 min. Referring ED was not significantly associated with discharge (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 0.43-3.83, = 0.792), discharge without any therapeutic procedure performed (OR: 1.47, 95% CI: 0.50-4.31, = 0.591), or length of stay (mean difference: 22.3 min, 95% CI: 84.5-39.9, = 0.471).
About a third of trauma transfers were unnecessary. Further collaborative efforts would be necessary to further define the situation in different health-care settings and exact reasons elucidated so that targeted interventions could be implemented to improve pediatric trauma care.
前往综合急诊科（ED）就诊的儿科创伤患者可能会被转至儿科急诊科进行进一步治疗。不必要的转运会增加医疗成本、加重工作量并降低满意度。因此，我们旨在评估不必要的儿科创伤转运比例，并描述这些转至儿科急诊科的患者特征。
对2017年1月至4月期间诊断为创伤相关病例进行回顾性病历审查。收集了有关患者人口统计学、诊断和临床进展的信息。如果患者在未进行任何治疗程序的情况下从儿科急诊科出院，则将此次转运定义为不必要。
共有117例创伤转运病例。平均年龄为8.3±4.9岁，77例（65.8%）为男性。95例（81.2%）转运来自重组医院。31例（26.5%）病例入院治疗。34例（29.1%）病例为不必要的转运。这些转运病例在急诊科的住院时间为118.4±87.1分钟。转诊急诊科与出院（比值比[OR]：1.28，95%置信区间[CI]：0.43 - 3.83，P = 0.792）、未进行任何治疗程序而出院（OR：1.47，95%CI：0.50 - 4.31，P = 0.591）或住院时间（平均差异：22.3分钟，95%CI：84.5 - 39.9，P = 0.471）均无显著相关性。
约三分之一的创伤转运是不必要的。需要进一步开展协作努力，以进一步明确不同医疗环境下的情况并阐明确切原因，从而实施有针对性的干预措施，改善儿科创伤护理。
