Preventable Transfers of Ingested Foreign Bodies in a Rural State

Introduction

Unnecessary transfer of pediatric patients with ingested foreign bodies presents significant social and financial burdens for patients and families. We sought to assess patient factors associated with potentially avoidable interfacility transfers after foreign body ingestion in a rural state.

Materials and methods

This is a multisite retrospective cohort study including patients < 18 y who were transferred to a tertiary pediatric hospital for surgical evaluation due to ingested foreign body between January 5, 2022, and April 30, 2024. Preventable transfer (PVT) was defined as any patient with an object below the gastroesophageal junction on pretransfer imaging not requiring surgical intervention or admission to any service for additional management of foreign body. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between patient factors and PVT.

Results

One hundred and seventy-one patients were included, with 26.3% (n = 45) identified as PVTs. No differences in demographic variables were seen between PVTs and nonpreventable transfers. Type of object was most commonly “other” in the preventable group and coin in the nonpreventable transfer group [60% versus 71%, P < 0.001]. Surgical consults were ordered for 74.3% (n = 126) of all transferred patients and almost half (46.7%, n = 21) of PVTs, despite 97.8% of PVTs being ultimately discharged from the emergency department.

Conclusions

Interfacility transfers of patients with ingested foreign bodies were characterized as preventable in over one-quarter of patients. These findings suggest an opportunity for interfacility transfer guideline standardization or implementation of telemedicine consultation to decrease overtriage and improve efficiency of health care utilization associated with this common pediatric chief complaint.