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[ Recorded presentation ] Recorded presentation

Benefits of transfer guidelines for pediatric trauma in pennsylvania

Christopher S. Hollenbeak, PhD1, Jennifer Findeis-Hosey, BS2, Robert E. Cilley, MD3, Stanley J. Kurek, DO4, Andreas Meier, MD3, and Peter W. Dillon, MD, MS3. (1) Surgery and Health Evaluation Sciences, Penn State College of Medicine, 500 University Drive, H113, Hershey, PA 17033, (2) Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, 717-531-5890, jfindeis@psu.edu, (3) Pediatric Surgery, Penn State College of Medicine, 500 University Drive, H113, Hershey, PA 17033, (4) Medicine, Lehigh Valley Hospital, 1200 S Cedar Crest Blvd, Allentown, PA 18103

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.






Predicted Deaths




Penetrating Injury



Penetrating Injury




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%)


Learning Objectives: At the end of this presentation, participants will

Keywords: Injuries, Child Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

[ Recorded presentation ] Recorded presentation

Emergency Medical Care and Transport

The 132nd Annual Meeting (November 6-10, 2004) of APHA