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Characteristics driving "inappropriate" transfer of pediatric mandibular fracture patients
Lucille Cheng, BA; Zhazira Irgebay, BA; Anne E. Glenney, BA; Jesse Goldstein, MD
University of Pittsburgh Medical Center
2023-02-08
Presenter: Lucille Cheng
Affidavit:
Certified
Director Name: Vu T. Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Mandibular fractures are among the most common pediatric facial fracture. Conservative treatment (i.e. jaw rest, chewing gum) are the most typical treatment methods and are widely available. However, pediatric patients are often transferred, leading to costly "inappropriate" transfers which often place undue burden on families while diverting resources from urgent cases. This study evaluates factors influencing "inappropriate" transfer, defined as a patient receiving conservative treatment post-transfer to a children's hospital.
A retrospective review was performed of patients under 18 years of age who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, etiology, medical history, associated injuries, treatments, and outcomes.
532 pediatric patients (141 female, 391 male) were included; more than half (56.77%, n = 302) were transferred. Of 302 total transfers, 178 (58.9%) were inappropriate. Subsequent treatment (conservative vs. surgical) did not differ significantly between transfer and non-transfer groups (p=0.72). Uninsured patients (p=0.038) or those with concomitant soft tissue injury (p=0.019) were more likely to be transferred. Trauma level, cause of injury, gender, and presence of other concomitant fractures did not significantly influence transfer rate.
Uninsured pediatric mandibular fracture patients were more likely to be transferred than their insured peers regardless of presenting trauma level. There was no difference in the rate of surgical management between transferred vs. non-transferred patients. Concurrent soft-tissue injuries were a significant factor influencing "inappropriate" transfers. We recommend research and innovation in remote plastic surgery consultations for pediatric patients who may not benefit from urgent transfer.
