Comparing Direct and Indirect Transfer Pathways for Pediatric Traumatic Brain Injury: Insights from a UK Specialist Neuroscience Center.

AI summary — for doctors, generated from the abstract only

In 375 UK pediatric TBI admissions, direct transfer to a specialist neuroscience center shortened time to neurosurgical care but was not associated with better recovery than indirect transfer via a trauma unit.

What was studied

Retrospective single specialist center study (2019-2024) of pediatric TBI admissions under UK national guidelines, comparing direct (184) vs indirect (191) transfer with propensity matching (156 vs 176) and GOS-E Peds outcomes.

Key findings

Good recovery 79% (direct) vs 80% (indirect); adjusted OR 1.02 (95% CI 0.57-1.86)
Times to CT, neurosurgical referral, and intervention significantly shorter with direct transfer (all p < 0.05)
No differences in length of stay, complications, or mortality
81.6% of matched cohort managed conservatively; protocol fidelity 95.2%

Clinical relevance

This suggests that current UK triage to indirect transfer for less severe pediatric TBI may not compromise outcomes, though the study may be underpowered for smaller differences and most patients did not need surgery.

Who should care

Neurosurgery

Limitations

Retrospective single-center data with residual confounding risk, mostly conservatively managed patients, and limited power to detect modest effects.

For children with TBI triaged per UK protocols, going first to a trauma unit delayed neurosurgical access but not recovery.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Optimal transfer strategies for pediatric traumatic brain injury remain debated: direct transfer to a specialist neuroscience center expedites access to neurosurgical care, whereas indirect transfer via a trauma unit allows initial stabilization before secondary transfer. We retrospectively analyzed 375 pediatric traumatic brain injury admissions managed under United Kingdom national guidelines (2019-2024): 184 (49%) were transferred directly to a specialist neuroscience center and 191 (51%) were initially transported to a trauma unit before secondary transfer. Outcomes were assessed using the Pediatric Glasgow Outcome Scale-Extended. The primary outcome was good recovery (upper or lower good); secondary outcomes were time to neurosurgical care, length of stay, complications, and mortality. Propensity score matching and generalized linear models were used to adjust for confounding, with a sensitivity analysis including patients with more than 30 days of follow-up. Protocol fidelity for triage to direct or indirect transfer was 95.2%. Before matching, patients in the direct transfer group were older and had more severe clinical features. In the matched cohort (156 direct, 176 indirect), 81.6% were managed conservatively. Although not statistically significant, follow-up duration was longer in the direct transfer group. Good recovery occurred in 79% of the direct group and 80% of the indirect group, with no significant association between transfer pathway and good recovery (adjusted odds ratio 1.02, 95% confidence interval 0.57-1.86). Times from injury to CT scan, neurosurgical referral, and neurosurgical intervention were significantly shorter in the direct transfer group (all p < 0.05). No between-group differences were observed in length of stay, inpatient or long-term complications, or mortality. The sensitivity analysis yielded concordant findings. Direct transfer shortened the time to neurosurgical care, but within the detectable effect size of this study, no pathway-related difference in clinical outcomes was demonstrated.

DOI

10.1177/08977151261433752

PMID

41852019