Pediatric Orthopaedic Transfers to a Level I Trauma Center: After-Hours Burden and Resident Preparedness.
- 1Albany Medical Center, Department of Orthopaedic Surgery, Albany, NY, USA.
- 2Albany Medical Center, Department of Pediatric Emergency Medicine, Albany, NY, USA.
- 3Albany Medical Center, Department of Emergency Medicine, Albany, NY, USA.
Abstract
Background
Level I pediatric trauma centers manage transferred orthopaedic injuries; however, interfacility transfer (IFT) patterns and educational implications for residents remain poorly characterized.Methods
We performed a retrospective cohort study of pediatric ground/air emergency medical service transport IFTs to a level I pediatric trauma center for orthopaedic injuries from 2016 to 2021. Variables included demographics, International Classification of Diseases 10th Revision (ICD-10)-coded injuries, referring facility (emergency departments [EDs] and urgent care centers [UCCs]), arrival time/season, length of stay (LOS), and disposition. Continuous and categorical variables were compared using standard methods, with statistical significance set at ⍺ = 0.05. ICD-10 codes were mapped to the American Academy of Orthopaedic Surgeons Resident Orthopaedic Core Knowledge (ROCK) contents to contextualize resident exposure.Results
Of the 695 transfers included, the predominant injuries were femur fractures (24%), upper extremity injuries (23%), hip injuries (13%), and knee injuries (6%). Transfers peaked in summer (33.5%), although there was no significant seasonal variation in source distribution, and most arrivals occurred during evening hours (15:00-22:59; 62%), with fewer night (30.2%, n = 210) and daytime (7.8%, n = 54) arrivals. Evening transfers were more likely to originate from EDs (90.5%) than from other sources (P < .001), and most transfers originated from EDs (82%) rather than from UCCs (14%). Compared with UCC transfers, ED transfers were associated with longer LOS (39.9 vs 27.5 hours; P = .04) and higher admission rates (63.3% vs 35.7%). All 25 injury categories were mapped onto the ROCK framework.Conclusions
Pediatric orthopaedic transfers were most common during evening and overnight hours in summer, with ED transfers demonstrating higher acuity and longer LOS. These patterns highlight a substantial after-hours burden and support targeted evening and night staffing models, including resident "buddy" call (junior and senior residents), advanced practice provider coverage, pediatric-trained nursing, and the early integration of ROCK content into on-call education.Key concepts
(1)Evenings and nights in a pediatric level I trauma center see a peak number of interfacility transfers/transfers from outside emergency departments (EDs), the majority of which are lower extremity fractures requiring overnight stabilization.(2)Fewer admissions of upper extremity fractures require closed reduction and casting, including knowledge of the successful parameters for sending out.(3)The American Academy of Orthopaedic Surgeons Resident Orthopaedic Core Knowledge curriculum includes sufficient depth and breadth regarding commonly encountered orthopaedic injuries in the ED and is therefore a valuable educational resource for training on-call residents.Level of evidence
III, Retrospective Cohort Study.
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BibTeX
@article{light2026pediatric,
title = {{Pediatric Orthopaedic Transfers to a Level I Trauma Center: After-Hours Burden and Resident Preparedness.}},
author = {Jonathan J Light and Carrie Danziger and Christopher Woll and Clayton Maschhoff and Ashar Ata and Andrew Rosenbaum and Michael Waxman and Denis Pauze},
journal = {Journal of the Pediatric Orthopaedic Society of North America},
year = {2026},
month = sep,
doi = {10.1016/j.jposna.2026.100458},
url = {https://europepmc.org/article/MED/42910168},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pediatric Orthopaedic Transfers to a Level I Trauma Center: After-Hours Burden and Resident Preparedness.
AU - Jonathan J Light
AU - Carrie Danziger
AU - Christopher Woll
AU - Clayton Maschhoff
AU - Ashar Ata
AU - Andrew Rosenbaum
AU - Michael Waxman
AU - Denis Pauze
PY - 2026
DA - 2026/09/17
JO - Journal of the Pediatric Orthopaedic Society of North America
DO - 10.1016/j.jposna.2026.100458
UR - https://europepmc.org/article/MED/42910168
AB - Background Level I pediatric trauma centers manage transferred orthopaedic injuries; however, interfacility transfer (IFT) patterns and educational implications for residents remain poorly characterized.Methods We performed a retrospective cohort study of pediatric ground/air emergency medical service transport IFTs to a level I pediatric trauma center for orthopaedic injuries from 2016 to 2021. Variables included demographics, International Classification of Diseases 10th Revision (ICD-10)-coded injuries, referring facility (emergency departments [EDs] and urgent care centers [UCCs]), arrival time/season, length of stay (LOS), and disposition. Continuous and categorical variables were compared using standard methods, with statistical significance set at ⍺ = 0.05. ICD-10 codes were mapped to the American Academy of Orthopaedic Surgeons Resident Orthopaedic Core Knowledge (ROCK) contents to contextualize resident exposure.Results Of the 695 transfers included, the predominant injuries were femur fractures (24%), upper extremity injuries (23%), hip injuries (13%), and knee injuries (6%). Transfers peaked in summer (33.5%), although there was no significant seasonal variation in source distribution, and most arrivals occurred during evening hours (15:00-22:59; 62%), with fewer night (30.2%, n = 210) and daytime (7.8%, n = 54) arrivals. Evening transfers were more likely to originate from EDs (90.5%) than from other sources (P < .001), and most transfers originated from EDs (82%) rather than from UCCs (14%). Compared with UCC transfers, ED transfers were associated with longer LOS (39.9 vs 27.5 hours; P = .04) and higher admission rates (63.3% vs 35.7%). All 25 injury categories were mapped onto the ROCK framework.Conclusions Pediatric orthopaedic transfers were most common during evening and overnight hours in summer, with ED transfers demonstrating higher acuity and longer LOS. These patterns highlight a substantial after-hours burden and support targeted evening and night staffing models, including resident "buddy" call (junior and senior residents), advanced practice provider coverage, pediatric-trained nursing, and the early integration of ROCK content into on-call education.Key concepts (1)Evenings and nights in a pediatric level I trauma center see a peak number of interfacility transfers/transfers from outside emergency departments (EDs), the majority of which are lower extremity fractures requiring overnight stabilization.(2)Fewer admissions of upper extremity fractures require closed reduction and casting, including knowledge of the successful parameters for sending out.(3)The American Academy of Orthopaedic Surgeons Resident Orthopaedic Core Knowledge curriculum includes sufficient depth and breadth regarding commonly encountered orthopaedic injuries in the ED and is therefore a valuable educational resource for training on-call residents.Level of evidence III, Retrospective Cohort Study.
SN - 2768-2765
ER -