Purpose.  To model formal guidelines for transferring pediatric patients between trauma centers and predict potential reductions in overall mortality in a statewide system.  Methods. Using data from the Pennsylvania Trauma Outcome Study (PTOS), we studied 24,172 pediatric trauma patients admitted to registered trauma centers in Pennsylvania between 1996 and 2002 and modeled the mortality that could be expected under hypothetical guidelines that would have transferred patients to a pediatric trauma center.  Results.  Mortality for pediatric patients was 3.0%, 8.2% and 4.4% at pediatric, level I and level II trauma centers, respectively.  Predicted mortality would have remained at 4.0% if all patients age <1 had been treated at a pediatric trauma center.  However, the model predicted a drop in overall mortality from 4.0% to 3.8% if patients age <1 or with a penetrating injury had been transferred.  A further drop from 968 deaths to 876 deaths, or a further drop in overall mortality to 3.6%, was predicted had patients with an injury severity score > 14 been treated at a pediatric trauma center.  Conclusions. Guidelines mandating the transfer to a pediatric trauma center of pediatric trauma patients less than 1 year of age, with penetrating injuries, and with ISS scores >14 would have saved the lives of 92 children in Pennsylvania.

 

	Deaths (Rate)	Predicted Deaths
		Age<1	Age<1 OR Penetrating Injury	Age<1 OR Penetrating Injury OR ISS>14
Pediatric	463 (3.0%)	471 (3.0%)	579 (3.5%)	821 (4.3%)
Level I	248 (8.2%)	246 (8.2%)	115 (5.2%)	26 (1.8%)
Level II	257 (4.4%)	254 (4.4%)	222 (4.1%)	29 (0.8%)
All Centers	968 (4.0%)	971 (4.0%)	916 (3.8%)	876 (3.6%)