ArticleJournal of the Pediatric Orthopaedic Society of North America2026
Operative Management and Time to Procedure for Transferred versus Direct-arrival Supracondylar Humerus Fractures at a Non-trauma-designated Children's Hospital.
Article in Journal of the Pediatric Orthopaedic Society of North America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: To evaluate operative management patterns and time to procedure for pediatric supracondylar humerus fractures at a non-trauma-designated children's hospital, comparing interfacility transfers with direct arrivals, and to assess whether transfer status may serve as an early indicator of surgical resource needs. Methods: We performed a retrospective cohort study of patients aged ≤14 years with supracondylar humerus fractures presenting to the emergency department of a Midwestern non-trauma-designated children's hospital (2010-2020). Outcomes included operative management, immediate surgery during the index encounter versus deferred surgery (return visit), and receiving-hospital arrival-to-procedure start time. Firth's penalized logistic regression was used for binary outcomes and linear regression of log-transformed time to identify independent predictors. Results: Among 464 patients, 136 (29.3%) were interfacility transfers. Transferred patients more frequently underwent surgery (94.1% vs 44.2%) and immediate surgery during the index encounter (91.9% vs 37.5%). Despite traveling a mean of 46 miles, transfers had shorter receiving-hospital arrival-to-procedure start times than direct arrivals (mean: 4.6 vs 6.3 h; 27% shorter; Conclusions: Transferred patients at a non-trauma-designated children's hospital had shorter receiving-hospital intervals to procedure start despite additional travel, likely reflecting pre-arrival triage and early activation. Transfer status-known at arrival-may function as a practical signal to initiate surgical team mobilization and operating room preparation. Key Concepts: (1)At a non-trauma-designated children's hospital, transferred pediatric supracondylar humerus fracture patients underwent surgery more often (94.1% vs 44.2%) and had shorter receiving-hospital arrival-to-procedure start times (mean 4.6 vs 6.3 h) than direct arrivals.(2)Transfer status was the strongest independent indicator of operative management, immediate surgery during the index encounter and shorter receiving-hospital arrival-to-procedure start time in adjusted models.(3)Among within-system transfers with segment timestamps, first-hospital arrival-to-procedure start time for distances <100 miles was comparable to direct arrivals' receiving-hospital arrival-to-procedure start time, suggesting transport time may be offset by parallel pre-arrival preparation.(4)Within transferred patients, nighttime arrival and transport durations longer than expected were associated with substantially longer time to procedure start.(5)Because transfer status is known at arrival, it may serve as a practical trigger for early orthopaedic team activation and operating room preparation. Level of Evidence: III (retrospective comparative study).
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