{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:38:22Z","timestamp":1783777102082,"version":"3.55.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The authors reviewed the transfer requests for isolated pediatric traumatic brain injuries (TBIs) at a Level I\/II facility with the goal of identifying clinical and radiographic traits associated with potentially avoidable transfers that could be safely managed in a non\u2013tertiary care setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors conducted a retrospective study of patients &lt; 18 years of age classified as having TBI and transferred to their Level I tertiary care center over a 12-year period. The primary outcome of interest was identifying potentially avoidable transfers, defined as transfers of patients not requiring any neurosurgical intervention and discharged 1 hospital day after admission.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Overall, 70.8% of pediatric patients with isolated TBI did not require neurosurgical intervention or monitoring, indicating an avoidable transfer. Potentially avoidable transfers were associated with outside hospital imaging that was negative (86%) or showed isolated, nondisplaced skull fractures (86%) compared to patients with cranial pathology (53.8%, p &lt; 0.001) as well as age \u2264 6 years (81% [negative imaging\/isolated, nondisplaced fractures] vs 54% [positive cranial pathology], p &lt; 0.001). The presence of headaches, nonfocal deficits, and loss of consciousness were associated with necessary transfer (p &lt; 0.05). Patients with potentially avoidable transfers underwent frequent repeat CT studies (19.1%) and admissions to the pediatric intensive care unit (55.9%) but at a lower rate than those whose transfers were necessary (p &lt; 0.001). Neurosurgical interventions occurred in 11% of patients with cranial pathology, which accounted for 17.9% of necessary transfers and 5.2% of all transfers.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>In the authors\u2019 region, potentially up to 70% of interfacility transfers for pediatric brain trauma in the absence of other systemic injuries warranting surgical intervention may not require neurosurgical intervention and could be managed locally. No patients transferred with isolated, nondisplaced skull fractures or negative CT scans required neurosurgical intervention, and 86% were discharged the day after admission. In contrast, 11% of patients with CT scans indicative of cranial pathology required neurosurgical intervention. Age &gt; 6 years, loss of consciousness, and nonfocal deficits were associated with a greater likelihood of needing a transfer. Further studies are required to clarify which patients can be managed at local institutions, but referring centers should practice overcaution given the potential risks.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.5.peds182","type":"journal-article","created":{"date-parts":[[2018,6,29]],"date-time":"2018-06-29T13:55:36Z","timestamp":1530280536000},"page":"375-383","source":"Crossref","is-referenced-by-count":8,"title":["Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center"],"prefix":"10.3171","volume":"22","author":[{"given":"Charles E.","family":"Mackel","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent C.","family":"Morel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse L.","family":"Winer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah G.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Sweeney","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Heller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Rideout","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron I.","family":"Riesenburger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven W.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Shriners Hospitals for Children\u2014Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","article-title":"Resources for Optimal Care of the Injured Patient","year":"2014","unstructured":"American College of Surgeons Committee on Trauma: Resources for Optimal Care of the Injured Patient. Chicago: American College of Surgeons, 2014 (https:\/\/www.facs.org\/\u223c\/media\/files\/quality%20programs\/trauma\/vrc%20resources\/resources%20for%20optimal%20care.ashx) [Accessed June 1, 2018]"},{"key":"b2","series-title":"J Emerg Trauma Shock","doi-asserted-by":"publisher","first-page":"12","DOI":"10.4103\/0974-2700.76824","article-title":"Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system","volume":"4","author":"Amini R","year":"2011","unstructured":"Amini R, Lavoie A, Moore L, Sirois MJ, Emond M: Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system. J Emerg Trauma Shock 4:12\u201319, 201110.4103\/0974-2700.76824"},{"key":"b3","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"703","DOI":"10.3171\/2015.4.PEDS1545","article-title":"Linear nondisplaced skull fractures in children: who should be observed or admitted?","volume":"16","author":"Arrey EN","year":"2015","unstructured":"Arrey EN, Kerr ML, Fletcher S, Cox CS Jr, Sandberg DI: Linear nondisplaced skull fractures in children: who should be observed or admitted? J Neurosurg Pediatr 16:703\u2013708, 201510.3171\/2015.4.PEDS1545"},{"key":"b4","series-title":"Emerg Med J","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1136\/emermed-2014-203930","article-title":"Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre: follow-up study","volume":"32","author":"Ashkenazi I","year":"2015","unstructured":"Ashkenazi I, Zeina AR, Kessel B, Peleg K, Givon A, Khashan T, : Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre: follow-up study. Emerg Med J 32:946\u2013950, 201510.1136\/emermed-2014-20393026446312"},{"key":"b5","series-title":"Telemed J","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1089\/tmj.1.1997.3.135","article-title":"Utilization and cost savings of a wide-area computer network for neurosurgical consultation","volume":"3","author":"Bailes JE","year":"1997","unstructured":"Bailes JE, Poole CC, Hutchison W, Maroon JC, Fukushima T: Utilization and cost savings of a wide-area computer network for neurosurgical consultation. Telemed J 3:135\u2013139, 199710.1089\/tmj.1.1997.3.13510168279"},{"key":"b6","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"605","DOI":"10.3171\/2013.9.JNS13640","article-title":"Caseload as a factor for outcome in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis","volume":"120","author":"Boogaarts HD","year":"2014","unstructured":"Boogaarts HD, van Amerongen MJ, de Vries J, Westert GP, Verbeek AL, Grotenhuis JA, : Caseload as a factor for outcome in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg 120:605\u2013611, 20142409363310.3171\/2013.9.JNS13640"},{"key":"b7","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1227\/01.neu.0000317320.79106.7e","article-title":"Neurosurgical emergency transfers to academic centers in Cook County: a prospective multicenter study","volume":"62","author":"Byrne RW","year":"2008","unstructured":"Byrne RW, Bagan BT, Slavin KV, Curry D, Koski TR, Origitano TC: Neurosurgical emergency transfers to academic centers in Cook County: a prospective multicenter study. Neurosurgery 62:709\u2013716, 20081842501710.1227\/01.neu.0000317320.79106.7e"},{"key":"b8","series-title":"J Am Coll Surg","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jamcollsurg.2007.06.285","article-title":"Secondary overtriage: a consequence of an immature trauma system","volume":"206","author":"Ciesla DJ","year":"2008","unstructured":"Ciesla DJ, Sava JA, Street JH III, Jordan MH: Secondary overtriage: a consequence of an immature trauma system. J Am Coll Surg 206:131\u2013137, 20081815557810.1016\/j.jamcollsurg.2007.06.285"},{"key":"b9","series-title":"J Surg Res","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1016\/j.jss.2015.03.077","article-title":"Secondary overtriage in a statewide rural trauma system","volume":"198","author":"Con J","year":"2015","unstructured":"Con J, Long D, Sasala E, Khan U, Knight J, Schaefer G, : Secondary overtriage in a statewide rural trauma system. J Surg Res 198:462\u2013467, 201510.1016\/j.jss.2015.03.077"},{"key":"b10","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1097\/01.sla.0000184169.73614.09","article-title":"The effect of trauma center designation and trauma volume on outcome in specific severe injuries","volume":"242","author":"Demetriades D","year":"2005","unstructured":"Demetriades D, Martin M, Salim A, Rhee P, Brown C, Chan L: The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg 242:512\u2013519, 200510.1097\/01.sla.0000184169.73614.0916192811"},{"key":"b11","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1097\/01.ta.0000242862.68899.04","article-title":"Socioeconomic factors, medicolegal issues, and trauma patient transfer trends: Is there a connection?","volume":"61","author":"Esposito TJ","year":"2006","unstructured":"Esposito TJ, Crandall M, Reed RL, Gamelli RL, Luchette FA: Socioeconomic factors, medicolegal issues, and trauma patient transfer trends: Is there a connection? J Trauma 61:1380\u20131388, 200610.1097\/01.ta.0000242862.68899.04"},{"key":"b12","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1136\/jnnp.2007.135178","article-title":"Observational approach to subjects with mild-to-moderate head injury and initial non-neurosurgical lesions","volume":"79","author":"Fabbri A","year":"2008","unstructured":"Fabbri A, Servadei F, Marchesini G, Stein SC, Vandelli A: Observational approach to subjects with mild-to-moderate head injury and initial non-neurosurgical lesions. J Neurol Neurosurg Psychiatry 79:1180\u20131185, 20081835625510.1136\/jnnp.2007.135178"},{"key":"b13","series-title":"Prehosp Emerg Care","doi-asserted-by":"publisher","first-page":"222","DOI":"10.3109\/10903127.2011.615013","article-title":"Large cost savings realized from the 2006 Field Triage Guideline: reduction in overtriage in U.S. trauma centers","volume":"16","author":"Faul M","year":"2012","unstructured":"Faul M, Wald MM, Sullivent EE, Sasser SM, Kapil V, Lerner EB, : Large cost savings realized from the 2006 Field Triage Guideline: reduction in overtriage in U.S. trauma centers. Prehosp Emerg Care 16:222\u2013229, 201210.3109\/10903127.2011.61501322008012"},{"key":"b14","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"1688","DOI":"10.1016\/j.jpedsurg.2016.05.022","article-title":"Preventable pediatric intensive care unit admissions over a 13-year period at a level 1 pediatric trauma center","volume":"51","author":"Fenton SJ","year":"2016","unstructured":"Fenton SJ, Campbell SJ, Stevens AM, Zhang C, Presson AP, Lee JH: Preventable pediatric intensive care unit admissions over a 13-year period at a level 1 pediatric trauma center. J Pediatr Surg 51:1688\u20131692, 201610.1016\/j.jpedsurg.2016.05.022"},{"key":"b15","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/j.jpedsurg.2015.09.020","article-title":"Preventable transfers in pediatric trauma: a 10-year experience at a level I pediatric trauma center","volume":"51","author":"Fenton SJ","year":"2016","unstructured":"Fenton SJ, Lee JH, Stevens AM, Kimbal KC, Zhang C, Presson AP, : Preventable transfers in pediatric trauma: a 10-year experience at a level I pediatric trauma center. J Pediatr Surg 51:645\u2013648, 201610.1016\/j.jpedsurg.2015.09.020"},{"key":"b16","series-title":"Acad Emerg Med","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1111\/j.1553-2712.2010.00918.x","article-title":"Survival benefit of transfer to tertiary trauma centers for major trauma patients initially presenting to nontertiary trauma centers","volume":"17","author":"Garwe T","year":"2010","unstructured":"Garwe T, Cowan LD, Neas B, Cathey T, Danford BC, Greenawalt P: Survival benefit of transfer to tertiary trauma centers for major trauma patients initially presenting to nontertiary trauma centers. Acad Emerg Med 17:1223\u20131232, 20102117552110.1111\/j.1553-2712.2010.00918.x"},{"key":"b17","series-title":"Pediatr Emerg Care","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1097\/PEC.0000000000000061","article-title":"Interhospital pediatric patient transfers-factors influencing rapid disposition after transfer","volume":"30","author":"Gattu RK","year":"2014","unstructured":"Gattu RK, Teshome G, Cai L, Wright C, Lichenstein R: Interhospital pediatric patient transfers-factors influencing rapid disposition after transfer. Pediatr Emerg Care 30:26\u201330, 20142436572410.1097\/PEC.0000000000000061"},{"key":"b18","series-title":"J Am Coll Surg","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.jamcollsurg.2012.03.018","article-title":"Impact of trauma center designation on outcomes: is there a difference between Level I and Level II trauma centers?","volume":"215","author":"Glance LG","year":"2012","unstructured":"Glance LG, Osler TM, Mukamel DB, Dick AW: Impact of trauma center designation on outcomes: is there a difference between Level I and Level II trauma centers? J Am Coll Surg 215:372\u2013378, 201210.1016\/j.jamcollsurg.2012.03.018"},{"key":"b19","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1080\/02688699746708","article-title":"The impact of teleradiology on the inter-hospital transfer of neurosurgical patients","volume":"11","author":"Goh KY","year":"1997","unstructured":"Goh KY, Lam CK, Poon WS: The impact of teleradiology on the inter-hospital transfer of neurosurgical patients. Br J Neurosurg 11:52\u201356, 199710.1080\/026886997467089156019"},{"key":"b20","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1016\/j.jpedsurg.2015.03.028","article-title":"Secondary overtriage in pediatric trauma: can unnecessary patient transfers be avoided?","volume":"50","author":"Goldstein SD","year":"2015","unstructured":"Goldstein SD, Van Arendonk K, Aboagye JK, Salazar JH, Michailidou M, Ziegfeld S, : Secondary overtriage in pediatric trauma: can unnecessary patient transfers be avoided? J Pediatr Surg 50:1028\u20131031, 201510.1016\/j.jpedsurg.2015.03.02825812448"},{"key":"b21","series-title":"CMAJ","first-page":"27","article-title":"Pediatric trauma: differences in pathophysiology, injury patterns and treatment compared with adult trauma","volume":"142","author":"Kissoon N","year":"1990","unstructured":"Kissoon N, Dreyer J, Walia M: Pediatric trauma: differences in pathophysiology, injury patterns and treatment compared with adult trauma. CMAJ 142:27\u201334, 19902403481"},{"key":"b22","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1016\/S0140-6736(09)61558-0","article-title":"Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study","volume":"374","author":"Kupperman N","year":"2009","unstructured":"Kupperman N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, : Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 374:1160\u20131170, 200910.1016\/S0140-6736(09)61558-0"},{"key":"b23","series-title":"Pediatr Emerg Care","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1097\/PEC.0000000000000863","article-title":"Utility of emergency department observation units for neurologically intact children with head CT abnormalities secondary to acute closed head injury","volume":"33","author":"Lefort R","year":"2017","unstructured":"Lefort R, Hunter JV, Cruz AT, Caviness AC, Luerssen TG, Adekunle-Ojo A: Utility of emergency department observation units for neurologically intact children with head CT abnormalities secondary to acute closed head injury. Pediatr Emerg Care 33:161\u2013165, 201710.1097\/PEC.000000000000086327918377"},{"key":"b24","series-title":"Am Surg","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1177\/000313481608200928","article-title":"Pediatric secondary overtriage in a statewide trauma system","volume":"82","author":"Leung A","year":"2016","unstructured":"Leung A, Bonasso P, Lynch K, Long D, Vaughan R, Wilson A, : Pediatric secondary overtriage in a statewide trauma system. Am Surg 82:763\u2013767, 201610.1177\/000313481608200928"},{"key":"b25","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1542\/peds.2011-1819","article-title":"Interfacility transfers of noncritically ill children to academic pediatric emergency departments","volume":"130","author":"Li J","year":"2012","unstructured":"Li J, Monuteaux MC, Bachur RG: Interfacility transfers of noncritically ill children to academic pediatric emergency departments. Pediatrics 130:83\u201392, 201210.1542\/peds.2011-181922665410"},{"key":"b26","series-title":"J Surg Res","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1016\/j.jss.2016.05.035","article-title":"Nationwide secondary overtriage in level 3 and level 4 trauma centers: are these transfers necessary?","volume":"204","author":"Lynch KT","year":"2016","unstructured":"Lynch KT, Essig RM, Long DM, Wilson A, Con J: Nationwide secondary overtriage in level 3 and level 4 trauma centers: are these transfers necessary? J Surg Res 204:460\u2013466, 201610.1016\/j.jss.2016.05.03527565083"},{"key":"b27","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1056\/NEJMsa052049","article-title":"A national evaluation of the effect of trauma-center care on mortality","volume":"354","author":"MacKenzie EJ","year":"2006","unstructured":"MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, : A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 354:366\u2013378, 200610.1056\/NEJMsa05204916436768"},{"key":"b28","series-title":"Acad Emerg Med","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1111\/acem.12972","article-title":"Potentially avoidable pediatric interfacility transfer is a costly burden for rural families: a cohort study","volume":"23","author":"Mohr NM","year":"2016","unstructured":"Mohr NM, Harland KK, Shane DM, Miller SL, Torner JC: Potentially avoidable pediatric interfacility transfer is a costly burden for rural families: a cohort study. Acad Emerg Med 23:885\u2013894, 201610.1111\/acem.1297227018337"},{"key":"b29","first-page":"945","article-title":"The impact of a telehealth web-based solution on neurosurgery triage and consultation. Telemed J E Health","volume":"16","author":"Moya M","year":"2010","unstructured":"Moya M, Valdez J, Yonas H, Alverson DC: The impact of a telehealth web-based solution on neurosurgery triage and consultation. Telemed J E Health 16:945\u2013949, 201021034238"},{"key":"b30","series-title":"J Trauma","first-page":"965","article-title":"The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments","volume":"63","author":"Newgard CD","year":"2007","unstructured":"Newgard CD, McConnell KJ, Hedges JR, Mullins RJ: The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments. J Trauma 63:965\u2013971, 200717993937"},{"key":"b31","series-title":"J Trauma","first-page":"602","article-title":"Rapid discharge after transfer: risk factors, incidence, and implications for trauma systems","volume":"69","author":"Osen HB","year":"2010","unstructured":"Osen HB, Bass RR, Abdullah F, Chang DC: Rapid discharge after transfer: risk factors, incidence, and implications for trauma systems. J Trauma 69:602\u2013606, 201020838132"},{"key":"b32","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1097\/00005373-200101000-00017","article-title":"Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry","volume":"50","author":"Osler TM","year":"2001","unstructured":"Osler TM, Vane DW, Tepas JJ, Rogers FB, Shackford SR, Badger GJ: Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry. J Trauma 50:96\u2013101, 20011123167710.1097\/00005373-200101000-00017"},{"key":"b33","series-title":"Am J Surg","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.amjsurg.2010.10.006","article-title":"Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care?","volume":"201","author":"Oyetunji TA","year":"2011","unstructured":"Oyetunji TA, Haider AH, Downing SR, Bolorunduro OB, Efron DT, Haut ER, : Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care? Am J Surg 201:445\u2013449, 20112142109710.1016\/j.amjsurg.2010.10.006"},{"issue":"2 Suppl","key":"b34","series-title":"J Trauma","first-page":"S114","article-title":"Disparities in the delivery of pediatric trauma care","volume":"67","author":"Petrosyan M","year":"2009","unstructured":"Petrosyan M, Guner YS, Emami CN, Ford HR: Disparities in the delivery of pediatric trauma care. J Trauma 67 (2 Suppl):S114\u2013S119, 200919667843"},{"key":"b35","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1016\/j.jpedsurg.2015.03.067","article-title":"Re-evaluating the need for hospital admission and observation of pediatric traumatic brain injury after a normal head CT","volume":"50","author":"Plackett TP","year":"2015","unstructured":"Plackett TP, Asturias S, Tadlock M, Wright F, Ton-That H, Demetriades D, : Re-evaluating the need for hospital admission and observation of pediatric traumatic brain injury after a normal head CT. J Pediatr Surg 50:1758\u20131761, 20152595702510.1016\/j.jpedsurg.2015.03.067"},{"key":"b36","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1097\/00005373-200008000-00009","article-title":"Impact of pediatric trauma centers on mortality in a statewide system","volume":"49","author":"Potoka DA","year":"2000","unstructured":"Potoka DA, Schall LC, Gardner MJ, Stafford PW, Peitzman AB, Ford HR: Impact of pediatric trauma centers on mortality in a statewide system. J Trauma 49:237\u2013245, 200010.1097\/00005373-200008000-00009"},{"key":"b37","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"e851","DOI":"10.1542\/peds.2014-2858","article-title":"Isolated linear skull fractures in children with blunt head trauma","volume":"135","author":"Powell EC","year":"2015","unstructured":"Powell EC, Atabaki SM, Wootton-Gorges S, Wisner D, Mahajan P, Glass T, : Isolated linear skull fractures in children with blunt head trauma. Pediatrics 135:e851\u2013e857, 201510.1542\/peds.2014-285825780067"},{"key":"b38","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1007\/s00381-016-3175-2","article-title":"Evaluation of the necessity of hospitalization in children with an isolated linear skull fracture (ISF)","volume":"32","author":"Reuveni-Salzman A","year":"2016","unstructured":"Reuveni-Salzman A, Rosenthal G, Poznanski O, Shoshan Y, Benifla M: Evaluation of the necessity of hospitalization in children with an isolated linear skull fracture (ISF). Childs Nerv Syst 32:1669\u20131674, 20162744429310.1007\/s00381-016-3175-2"},{"key":"b39","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1016\/j.jpedsurg.2010.12.019","article-title":"Neurologically intact children with an isolated skull fracture may be safely discharged after brief observation","volume":"46","author":"Rollins MD","year":"2011","unstructured":"Rollins MD, Barnhart DC, Greenberg RA, Scaife ER, Holsti M, Meyers RL, : Neurologically intact children with an isolated skull fracture may be safely discharged after brief observation. J Pediatr Surg 46:1342\u20131346, 201110.1016\/j.jpedsurg.2010.12.01921763832"},{"key":"b40","series-title":"JAMA Surg","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1001\/jamasurg.2015.1121","article-title":"Mortality among injured children treated at different trauma center types","volume":"150","author":"Sathya C","year":"2015","unstructured":"Sathya C, Alali AS, Wales PW, Scales DC, Karanicolas PJ, Burd RS, : Mortality among injured children treated at different trauma center types. JAMA Surg 150:874\u2013881, 20152610684810.1001\/jamasurg.2015.1121"},{"key":"b41","series-title":"JAMA Surg","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1001\/jamasurg.2013.2132","article-title":"Secondary overtriage: the burden of unnecessary interfacility transfers in a rural trauma system","volume":"148","author":"Sorensen MJ","year":"2013","unstructured":"Sorensen MJ, von Recklinghausen FM, Fulton G, Burchard KW: Secondary overtriage: the burden of unnecessary interfacility transfers in a rural trauma system. JAMA Surg 148:763\u2013768, 201310.1001\/jamasurg.2013.2132"},{"key":"b42","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"2311","DOI":"10.1097\/01.CCM.0000146132.29042.4C","article-title":"Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team","volume":"32","author":"Suarez JI","year":"2004","unstructured":"Suarez JI, Zaidat OO, Suri MF, Feen ES, Lynch G, Hickman J, : Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med 32:2311\u20132317, 20041564064710.1097\/01.CCM.0000146132.29042.4C"},{"key":"b43","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1097\/TA.0000000000000462","article-title":"A critical analysis of secondary overtriage to a Level I trauma center","volume":"77","author":"Tang A","year":"2014","unstructured":"Tang A, Hashmi A, Pandit V, Joseph B, Kulvatunyou N, Vercruysse G, : A critical analysis of secondary overtriage to a Level I trauma center. J Trauma Acute Care Surg 77:969\u2013973, 20142542354010.1097\/TA.0000000000000462"},{"key":"b44","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1097\/TA.0000000000000604","article-title":"Acute outcomes of isolated cerebral contusions in children with Glasgow Coma Scale scores of 14 to 15 after blunt head trauma","volume":"78","author":"Varano P","year":"2015","unstructured":"Varano P, Cabrera KI, Kuppermann N, Dayan PS: Acute outcomes of isolated cerebral contusions in children with Glasgow Coma Scale scores of 14 to 15 after blunt head trauma. J Trauma Acute Care Surg 78:1039\u20131043, 201510.1097\/TA.000000000000060425909428"},{"key":"b45","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1097\/TA.0b013e31829a0a65","article-title":"The effect of trauma center care on pediatric injury mortality in California, 1999 to 2011","volume":"75","author":"Wang NE","year":"2013","unstructured":"Wang NE, Saynina O, Vogel LD, Newgard CD, Bhattacharya J, Phibbs CS: The effect of trauma center care on pediatric injury mortality in California, 1999 to 2011. J Trauma Acute Care Surg 75:704\u2013716, 20132406488710.1097\/TA.0b013e31829a0a65"},{"key":"b46","series-title":"JAMA Pediatr","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1001\/jamapediatrics.2016.0805","article-title":"Association between trauma center type and mortality among injured adolescent patients","volume":"170","author":"Webman RB","year":"2016","unstructured":"Webman RB, Carter EA, Mittal S, Wang J, Sathya C, Nathens AB, : Association between trauma center type and mortality among injured adolescent patients. JAMA Pediatr 170:780\u2013786, 201610.1001\/jamapediatrics.2016.080527368110"},{"key":"b47","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"602","DOI":"10.3171\/2015.9.PEDS15352","article-title":"Transfer of children with isolated linear skull fractures: is it worth the cost?","volume":"17","author":"White IK","year":"2016","unstructured":"White IK, Pestereva E, Shaikh KA, Fulkerson DH: Transfer of children with isolated linear skull fractures: is it worth the cost? J Neurosurg Pediatr 17:602\u2013606, 20162672275910.3171\/2015.9.PEDS15352"},{"key":"b48","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1542\/peds.2006-2900","article-title":"Access to optimal emergency care for children","volume":"119","author":"Yamamoto LG","year":"2007","unstructured":"Yamamoto LG: Access to optimal emergency care for children. Pediatrics 119:161\u2013164, 200710.1542\/peds.2006-290017200284"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/22\/4\/article-p375.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/22\/4\/article-p375.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/22\/4\/article-p375.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:36:55Z","timestamp":1681565815000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/22\/4\/article-p375.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10]]},"references-count":48,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2018.5.peds182","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10]]}}}