728 - Where Did They Go? Transport Destinations for Injured Children with Access to Pediatric Trauma Centers

Publication Number: 3704.728

Kendall J. Donohue, Boston Children's Hospital, Boston, MA, United States; Lois Lee, Boston Children's Hospital, Boston, MA, United States; Michael Monuteaux, Boston Children's Hospital, Boston, MA, United States; Eric Fleegler, MassGeneral Hospital for Children, needham, MA, United States; Caitlin Farrell, Boston Children's Hospital, Nat, MA, United States

Background: Injury is the leading cause of death for US children. Treatment at pediatric trauma centers (PTCs) improves outcomes, yet recent research demonstrated that nearly 60% of injured children with geographic access to a PTC are transported elsewhere for care.

Objective: To describe the population of injured children needing trauma center care who have geographic access to a PTC but are instead transported by EMS to a general trauma center (GTC) or non-trauma center. Compare demographic and incident-level differences between patients with PTC access who were transported to a GTC vs a non-trauma center.

Design/Methods: This is a retrospective study using 2019-2021 National Emergency Medical Services Information System data. Children < 16 years with ICD-10 injury codes who met American College of Surgeons (ACS) field triage criteria for trauma center transport were included. Geographic PTC access was defined as an injury location zip code within a 60-minute drive to a Level 1 or 2 PTC using ArcGIS road network analysis. We reported patient demographics, injury mechanism, and transport variables. We compared transport destination (GTC vs non-trauma center) using chi square or Wilcoxon rank sum tests.

Results: Between 2019-2021, 32,616 injured children, meeting ACS field triage criteria and with PTC geographic access, were not transported to a PTC. The majority were in urban areas (93.9%), male (59%), and the highest proportion were ages 5-12 years (39.6%) (Table 1). Only 15% (4,885) were transported to a Level 1 or Level 2 GTC. Despite having geographic access to a PTC, 85% were transported to a non-trauma center. There were differences in age, sex, mechanism of injury, urbanicity, and census region when comparing children transported to GTCs vs non-trauma centers (Table 1). Median transport times differed between those transported to GTCs (16.6 min [10.6, 24.5] and non-trauma centers (14.1min [IQR 8.7, 22.0] p< 0.001).

Conclusion(s): Among injured children meeting ACS triage criteria with geographic PTC access, the majority were transported to non-trauma centers rather than GTCs. Understanding barriers for EMS transport to PTCs when geographically available can inform triage policy and education.

Table 1. Transport Destination for Patients with ACS Triage Criteria for Trauma Center Transport and Geographic Access to a Pediatric Trauma Center (PTC) that were NOT Transported to a PTC
GCS = Glasgow Coma Scale; EMS = emergency medicine services; BLS=Basic Life Support; Advanced Life Support; CPR = cardiopulmonary resuscitation
1 Chi square and Wilcoxon rank sum tests for categorical and continuous variables, respectively
2 Location of injury/911 call is the same as the patient's home zip code