The pattern of emergency department utilization in pediatric patients who underwent interfacility transfers from the emergency department: a nationwide population-based study in South Korea, 2016-2018

Purpose: The shortage of pediatric emergency care has become a significant societal issue. This study investigated the usage pattern of emergency departments (EDs) by pediatric patients who underwent interfacility transfers (IFTs) in South Korea, focusing on cases involving single and double IFTs.Methods: This nationwide cross-sectional study included all pediatric patients (< 19 years) who underwent IFTs at regional and local emergency medical centers from 2016 through 2018, using data from the National Emergency Department Information System. After excluding unidentified cases, clinical features and ED use patterns were compared between patients with single IFT, i.e., an IFT after the initial ED visit, and those with double IFT, i.e., a sequential transfer from one medical facility to another.Results: Among 20,888 pediatric cases of IFTs in the ED, 21.0% of disease cases (3,070/14,624) and 11.4% of injury cases (691/6,038) experienced double IFTs. The double-transfer group showed a lower proportion of high acuity than the single-transfer group (22.6% vs. 15.0%; P < 0.001). However, median values of ED length of stay were longer in the double-transfer group, regardless of type of cases (disease: 163 minutes [single] vs. 218 minutes [double]; injury, 111 minutes vs. 172 minutes; all Ps < 0.001). Guardian’s request was a substantial reason for double IFT (disease, 29.9% [919/3,070]; injury, 56.4% [390/691]).Conclusion: Double IFT is common in pediatric patients and strains medical resources, regardless of severity. The high occurrence of double IFT driven by guardians’ requests rather than medical emergencies underscores the need for improved awareness of the emergency medical system among pediatric patients’ caregivers.