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Resource utilization and disparity characteristics associated with potentially avoidable transfers of pediatric patients with facial fractures
Lucille G. Cheng, BA1, Aniket Dhariwal, BA1, Anne E. Glenney, BA2, Shirley Xiaosu Liu, BS1, Richard A. Saladino, MD3, Lucas A. Dvoracek, MD2; Jesse A. Goldstein, MD2
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
"Potentially avoidable" transfers (PAT) of pediatric facial fracture patients place undue burden on families to travel outside their communities while diverting resources from urgent cases. Previous work has focused on characterizing these transfers in specific injury subtypes, but it is critical to examine factors influencing transfer and understand the impact of these transfers, on a larger patient cohort and broader craniofacial fracture spectrum.
A retrospective review was performed of patients under 18 years of age who were evaluated for facial fractures at a pediatric level I trauma center between 2006 and 2021. PAT was defined as a patient with a length of stay less than one day, no admission, no surgery, and no emergency procedure performed after transfer. Variables studied included demographics, etiology, medical history, associated injuries, treatments, and outcomes.
3120 pediatric patients were included; nearly half (40.1%) were transferred and 299 (24.1% were categorized as PAT. Key patient characteristics associated with PAT likelihood were Black race (p=0.036), being uninsured (p=0.004), less than 6 years of age (p=0.008), and orbit or mandible fractures (p=0.001 and p=0.007, respectively). Odds ratio analysis demonstrated TAP likelihood was 3 times higher for a Black patient with mandible or orbit fracture (p=0.001 and 0.004, respectively).
"Potentially avoidable" transfers are a significant burden to patients and hospital systems. This study describes factors associated with such transfers in pediatric facial fractures using one of the largest pediatric facial fracture databases to date. We recommend further research in causes of racial and socioeconomic transfer disparities and improvement in transfer protocols.
