{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:28:26Z","timestamp":1790908106229,"version":"4.1.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum RWTH Aachen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Particularly for pediatric trauma patients, it is of utmost importance that the right patient be treated in the right place at the right time. While unnecessary interhospital transfers must be avoided, the decision against transfer should not lead to higher complication rates in trauma centers without added pediatric qualifications. We therefore identified independent predictive factors for an early transfer of severely injured patients and compared these factors with the current transfer recommendations of the German Trauma Society. Additionally, the quality of the self-assessment based on the mortality of children who were not transferred was evaluated. A national dataset from the TraumaRegister DGU\n                    <jats:sup>\u00ae<\/jats:sup>\n                    was used to retrospectively identify factors for an early interhospital transfer (&lt;\u200948\u00a0h) to a superordinate trauma center. Severely injured pediatric patients (age\u2009&lt;\u200916\u00a0years) admitted between 2010 and 2019 were included in this analysis. Adjusted odds ratios (OR) with 95% confidence intervals (CI) for early transfer were calculated from a multivariable model. Prognostic factors for hospital mortality in non-transferred patients were also analyzed. In total, 6069 severely injured children were included. Of these, 65.2% were admitted to a Level I trauma center, whereas 27.7% and 7.1% were admitted to Level II and III centers, respectively. After the initial evaluation in the emergency department, 25.5% and 50.1% of children primarily admitted to a Level II or III trauma center, respectively, were transferred early. Statistically significant predictors of an early transfer were: Serious traumatic brain injury (OR 1.76, 95% CI 1.28\u20132.43), Injury severity score (ISS)\u2009\u2265\u200916 points (ISS 16\u201324: OR 2.06, 95% CI 1.59\u20132.66; ISS 25\u201333: OR 3.0, 95% CI 2.08\u20134.31; ISS 34\u201375: OR 5.42, 95% CI 3.0\u20139.81, reference category: ISS 9\u201315), age\u2009&lt;\u200910\u00a0years (age 0\u20131: OR 1.91, 95% CI 1.34\u20132.71; age 2\u20135: 2.04, 95% CI 1.50\u20132.78; age 6\u20139: 1.62, 95% CI 1.23\u20132.14; reference category: age 10\u201315). The most important independent factor for mortality in non-transferred patients was age\u2009&lt;\u200910\u00a0years (age 0\u20131: 5.35, 95% CI 3.25\u20138.81; age 2\u20135: 2.46, 95% CI 1.50\u20134.04; age 6\u20139: OR 1.7, 95% CI 1.05\u20132.75; reference category: age 10\u201315). Knowing the independent predictors for an early transfer, such as a young patient's age, a high injury severity, serious traumatic brain injury (TBI), may improve the choice of the appropriate trauma center. This may guide the rapid decision for an early interhospital transfer. There is still a lack of outcome data on children with early interhospital transfers in Germany, who are the most vulnerable group.\n                  <\/jats:p>","DOI":"10.1038\/s41598-023-39335-8","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T06:02:48Z","timestamp":1690437768000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Adherence to the transfer recommendations of the German Trauma Society in severely injured children: a retrospective study from the TraumaRegister DGU"],"prefix":"10.1038","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7419-8687","authenticated-orcid":false,"given":"Felix Marius","family":"Bl\u00e4sius","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Laubach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Lefering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Hildebrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagen","family":"Andruszkow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"39335_CR1","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s00101-017-0265-9","volume":"66","author":"P Hilbert-Carius","year":"2017","unstructured":"Hilbert-Carius, P. et al. Care for severely injured persons: Update of the 2016 S3 guideline for the treatment of polytrauma and the severely injured. Anaesthesist 66, 195\u2013206. https:\/\/doi.org\/10.1007\/s00101-017-0265-9 (2017).","journal-title":"Anaesthesist"},{"key":"39335_CR2","unstructured":"German Trauma Society. Whitebook Medical Care of the Severely Injured 2nd revised and updated edition. Availabe online: https:\/\/www.dgu-online.de\/fileadmin\/published_content\/5.Qualitaet_und_Sicherheit\/PDF\/2012_DGU_Whitebook_Medical_Care_2ndEdition.pdf (Accessed 17 Jan 2021)."},{"key":"39335_CR3","doi-asserted-by":"publisher","first-page":"1518","DOI":"10.1016\/j.jpedsurg.2016.04.010","volume":"51","author":"MA Escobar Jr","year":"2016","unstructured":"Escobar, M. A. Jr. & Morris, C. J. Using a multidisciplinary and evidence-based approach to decrease undertriage and overtriage of pediatric trauma patients. J. Pediatr. Surg. 51, 1518\u20131525. https:\/\/doi.org\/10.1016\/j.jpedsurg.2016.04.010 (2016).","journal-title":"J. Pediatr. Surg."},{"key":"39335_CR4","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s13017-021-00372-1","volume":"16","author":"S Gianola","year":"2021","unstructured":"Gianola, S. et al. Accuracy of pre-hospital triage tools for major trauma: A systematic review with meta-analysis and net clinical benefit. World J. Emerg. Surg. 16, 31. https:\/\/doi.org\/10.1186\/s13017-021-00372-1 (2021).","journal-title":"World J. Emerg. Surg."},{"key":"39335_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13017-020-00345-w","volume":"16","author":"FX Ageron","year":"2021","unstructured":"Ageron, F. X. et al. Effect of under triage on early mortality after major pediatric trauma: A registry-based propensity score matching analysis. World J. Emerg. Surg. 16, 1. https:\/\/doi.org\/10.1186\/s13017-020-00345-w (2021).","journal-title":"World J. Emerg. Surg."},{"issue":"Suppl 3","key":"39335_CR6","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.1016\/j.injury.2014.08.011","volume":"45","author":"DGU TraumaRegister","year":"2014","unstructured":"TraumaRegister, D. G. U. 20 years TraumaRegister DGU((R)): Development, aims and structure. Injury 45(Suppl 3), S6\u2013S13. https:\/\/doi.org\/10.1016\/j.injury.2014.08.011 (2014).","journal-title":"Injury"},{"key":"39335_CR7","doi-asserted-by":"publisher","first-page":"837","DOI":"10.3390\/jcm10040837","volume":"10","author":"FM Bl\u00e4sius","year":"2021","unstructured":"Bl\u00e4sius, F. M. et al. Helicopter emergency medical service and hospital treatment levels affect survival in pediatric trauma patients. J. Clin. Med. 10, 837 (2021).","journal-title":"J. Clin. Med."},{"key":"39335_CR8","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","volume":"14","author":"SP Baker","year":"1974","unstructured":"Baker, S. 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Update of the trauma risk adjustment model of the TraumaRegister DGU: the Revised Injury Severity Classification, version II. Crit. Care 18, 476. https:\/\/doi.org\/10.1186\/s13054-014-0476-2 (2014).","journal-title":"Crit Care."},{"key":"39335_CR13","doi-asserted-by":"publisher","first-page":"R124","DOI":"10.1186\/cc12796","volume":"17","author":"H Andruszkow","year":"2013","unstructured":"Andruszkow, H. et al. Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients. Crit. Care 17, R124. https:\/\/doi.org\/10.1186\/cc12796 (2013).","journal-title":"Crit. Care"},{"key":"39335_CR14","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1007\/BF01709751","volume":"18","author":"R van der Sluijs","year":"2018","unstructured":"van der Sluijs, R., van Rein, E. A. J., Wijnand, J. G. J., Leenen, L. P. H. & van Heijl, M. Accuracy of Pediatric Trauma Field Triage: A Systematic Review. 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The other authors declare no personal competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"12152"}}