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Pediatric Upper Extremity Emergency Room Transfers: Are They Warranted
Xuyang Song, MD; Rory Carroll, BS; Joshua M. Abzug, MD
University of Maryland, Baltimore, MD

Introduction: Emergency room transfers to a higher level of care is a vital component of modern healthcare in order to permit the optimal care of patients by providing access to specialized personnel and facilities. However, literature has shown that transfers to a higher level of care facility for an adult hand injury are frequently unnecessary. Furthermore, adult hand emergency room transfers have been shown to be higher during “off-hours” and weekends, and are frequently based on insurance status. The purpose of this study was to evaluate the appropriateness of pediatric upper extremity transfers to a tertiary care center and the factors surrounding them.
Materials & Methods: A retrospective review was performed of all pediatric emergency room transfers to our tertiary care facility over a 1 year period. All cases that involved the upper extremity were reviewed to assess patient demographics, the time of the request for transfer, the day of the week of the transfer, insurance status, whether or not the patient went to the operating room, whether or not a closed reduction maneuver was performed in the emergency department, and whether or not conscious sedation was provided in the emergency department. Simple statistical analysis was performed.
Results: 61% (46/75) pediatric orthopedic emergency room transfers were cases related to the upper extremity, all of which were fractures. 30% (14/46) transfers occurred on the weekend. 24% (11/46) transfers involved patients with Medicaid.
63% (29/46) of cases required a procedure in the operating room, and 33% (15/46) had a closed reduction procedure performed in the emergency room. 24% (11/46) had conscious sedation provided in the emergency room. Only 6.5% (3/46) of transfers did not require any of these three factors.
Conclusion: The vast majority of pediatric upper extremity transfers are warranted requiring either operative intervention, a closed reduction maneuver, or conscious sedation. Unlike adult hand transfers, the majority of pediatric upper extremity transfers do not seem to be influenced by time of day/week or insurance status. While transfer of a patient to a tertiary care facility does increase healthcare costs, pediatric upper extremity transfers are an appropriate use of resources.

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