Emergency Pediatric Orthopaedic Transfer Criteria: A Pilot Study.

Gregory S Mowrer, Nicholas I Pilla, Scott M Sorenson, Douglas G Armstrong, William L Hennrikus
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Abstract

The purpose of this study was to define pediatric orthopaedic transfer criteria for patients coming from a smaller facility to a Level I pediatric trauma center. A 10-question phone survey was utilized for every transfer request. Fifty-eight transfer requests were prospectively collected and retrospectively reviewed. The criteria were based on The American Academy of Pediatrics (AAP) guidelines and the expert opinion of the senior author. The AAP criteria included complex fractures/dislocations and bone and joint infections. The expert opinion criteria included a patient requiring admission to the hospital or a patient needing surgery. All centers requesting transfers were staffed by an on-call board-certified general orthopaedic surgeon with the ability to care for pediatric orthopaedic injuries. Of the 58 transfers, 37 (64%) did not meet transfer criteria; 21 (36%) met transfer criteria. Transfer requests came from Emergency Department (ED) physicians in 25/58 cases (43%), physician assistants in 11/58 (19%), orthopaedic attending physicians in 3/58 (5%), and orthopaedic residents in 3/58 (5%). The orthopaedic surgeon at the referring hospital examined the patient in only six instances (10%) prior to transfer. Of the 58 patients, 18 (31%) required a hospital admission, and 17 (29%) patients were indicated for surgery. In the current study, 64% of pediatric orthopaedic transfers did not meet criteria for an inter-facility hospital to hospital transfer and were potentially avoidable. (Journal of Surgical Orthopaedic Advances 32(3):182-186, 2023).

儿科骨科急诊转院标准:试点研究。
这项研究的目的是为从小型医疗机构转往一级儿科创伤中心的患者制定儿科骨科转院标准。对每一个转院申请都进行了 10 个问题的电话调查。对 58 份转院申请进行了前瞻性收集和回顾性审查。转院标准基于美国儿科学会(AAP)指南和资深作者的专家意见。美国儿科学会的标准包括复杂骨折/脱位和骨关节感染。专家意见标准包括需要入院的患者或需要手术的患者。所有要求转院的中心都配备了一名有资质的普通骨科外科医生值班,该外科医生有能力治疗小儿骨科损伤。在 58 例转院患者中,37 例(64%)不符合转院标准;21 例(36%)符合转院标准。转院请求来自急诊科(ED)医生的有 25/58 例(43%),来自助理医生的有 11/58 例(19%),来自骨科主治医生的有 3/58 例(5%),来自骨科住院医生的有 3/58 例(5%)。转诊医院的骨科医生在转院前对患者进行检查的只有 6 例(10%)。在 58 名患者中,18 人(31%)需要入院治疗,17 人(29%)有手术指征。在目前的研究中,64% 的小儿骨科转院不符合医院间转院的标准,有可能是可以避免的。(外科骨科进展杂志》32(3):182-186,2023)。
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