Assessing the Effectiveness of Interfacility Transfers for Pediatric Facial Fractures: A Comprehensive Multi-Level 1 Trauma Center Analysis with Proposed Transfer Guidelines

Abstract

Study Design: Retrospective chart review. Background: Pediatric patients with facial trauma are often transferred to specialized trauma centers for advanced evaluations, but the necessity and impact of these transfers remain uncertain. This study aims to assess the need for interfacility transfers and inform the development of evidence-based transfer guidelines for this population. Methods: This retrospective study analyzed data from pediatric facial trauma patients under 18 years old treated between January 2020 and December 2022 at two major Level 1 Trauma Centers. Data was analyzed using Chi-square and Student’s T-Tests, with a significance value of 5%. Results: Of 2,977 patients evaluated, 604 sustained at least one facial fracture. Transferred patients were more likely to present with mandible fractures, while primary evaluation patients had a higher incidence of midface fractures. Transfers for midface fractures were associated with high-energy trauma, open or comminuted fractures, and specialized conservative evaluations. Patients with midface fractures were often transferred for specialized operative treatments but more often received conservative management with no significant impact on outcomes. Transferred patients experienced longer hospital stays and reported more residual symptoms post-discharge, with lower rates of symptom resolution within 1 year. Conclusion: While midface fractures were a frequent reason for transfer, conservative management was typically performed without significant improvements in outcomes. These findings suggest that many transfers could be avoided by implementing interfacility guidelines that account for trauma type, radiographic findings, and access to outpatient care. Streamlining transfer decisions may reduce unnecessary resource use for cases not requiring urgent surgical intervention.