Journal Article

Outcomes of children transferred to a pediatric trauma center after blunt abdominal trauma: A 10-year experience

Reisch, Joan S., Nesiama, Jo-Ann O., Nesiama, Ediri, Mehmood, Noormah, Guiner, Alessandra, Yancovich, Shannon E., Ragle, Parker

2025

Overview

Most injured children are initially seen at non-pediatric hospitals, then transferred to a pediatric trauma center for definitive care. Published outcomes of transferred children with blunt abdominal trauma (BAT) are sparse. Our objective is to describe this population and their disposition at a pediatric trauma center. The study was performed at a level-1 pediatric trauma center (PTC) using data collected from electronic medical records and trauma registry. Patients 0-18 years with BAT transferred from outside facilities (OSF) between 2009 and 2019. Penetrating injuries were excluded. 923 patients were analyzed and grouped by whether computed tomography abdominal/pelvis (CTa/p) was obtained at each facility. Those with positive CTa/p at OSF were also compared to those with positive CTa/p results at our PTC. Descriptive statistics evaluated demographics, injury mechanism, Glasgow Coma Scale (GCS), Injury Severity Scale (ISS), disposition, and length of stay (LOS). Males had higher predominance of positive CTa/p at both OSF and PTC (p = 0.0012), with motor vehicle crash (MVC) being the most common injury mechanism (p = 0.0002). Patients with positive CTa/p at PTC (n = 156) were associated with statistically higher ISS, lower GCS, more dispositions to OR and ICU, and longer LOS (all p < 0.005). Of patients with negative CTa/p at OSF (n = 41), none received subsequent CTa/p upon arrival to PTC and only 2 were admitted in the setting of head trauma. Of the patients without CTa/p performed at either facility or negative CTa/p at PTC (n = 23), most were admitted for non-abdominal trauma. Compared to those with positive CTa/p at OSF, children who had positive CTa/p at PTC were younger, had higher ISS scores, and longer LOS, suggesting they were more seriously injured. Children with BAT and negative CTa/p in absence of other injuries, may not require transfer to a PTC. Enhanced understanding of these patients may reduce unnecessary transfers, improving resource utilization. •A significant number of children sustaining blunt abdominal trauma undergo transfer.•Emerging literature on their management differs from widely accepted guidelines.•This retrospective study describes transferred children with blunt abdominal trauma.•Patients who were transferred without CT at transferring facility were younger.•Patients found to have positive CT after transfer were younger and more injured.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Abdomen / Abdominal injuries / Abdominal Injuries - diagnostic imaging / Abdominal Injuries - epidemiology / Abdominal Injuries - therapy / Adolescent / Blunt abdominal trauma / Child / Child, Preschool / Children / Computed tomography / Electronic medical records / Emergency / Emergency medical care / Female / Glasgow Coma Scale / Humans / Infant / Infant, Newborn / Injuries / Injury Severity Score / Length of Stay - statistics & numerical data / Male / Medical records / Motor vehicles / Patient Transfer - statistics & numerical data / Patients / Pediatric trauma center / Pediatrics / Pelvis / Population studies / Registries / Resource utilization / Retrospective Studies / Tomography, X-Ray Computed / Transferred children / Trauma / Trauma centers / Trauma Centers - statistics & numerical data / Wounds, Nonpenetrating - diagnostic imaging / Wounds, Nonpenetrating - therapy