Urban and rural patterns in emergent pediatric transfer: A call for regionalization

Timothy Horeczko, James P. Marcin, Jeremy M. Kahn, Robert E. Sapien, Julie Rabeau, Tomi Mars, Marianne Gausche-Hill, Larry Karsteadt, Emily Kim, Nathan Kuppermann, Pamela Mather, Kenneth Stiver, Cheryl Wraa, James DeTienne, Joseph D. Hansen D., Scott Watson, Kathryn Felmet, Melinda Hamilton, Richard Saladino

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Context: National groups call for the regionalization of health care, to direct patients with high-risk conditions to designated hospitals with greater capabilities. Currently there is limited information detailing the characteristics and specific needs of acutely ill and injured children who require transfer to another institution, especially in underserved rural communities. Purpose: To determine the epidemiology of pediatric transfers from urban and rural emergency departments (EDs). Methods: We analyzed data in the National Hospital Ambulatory Medical Care Survey from 1995 to 2010. Eligible children were <18 years of age seen in a United States ED, and transferred to another hospital after initial evaluation. Findings: Of all 283,232,058 pediatric ED visits, less than 0.5% resulted in a transfer, yielding a population-based estimate of 900,100 transfers nationally during this period. Urban and rural EDs showed similar transfer rates. Children transferred from rural EDs were older and more likely to arrive by emergency medical services than children transferred from urban EDs (12.1 vs 8.2 years of age, P < .01). Children from rural EDs were more than twice as likely to be transferred for a psychiatric indication (43.5% vs 19.5%, P < .01). Conclusions: Emergency pediatric transfers are uncommon in the United States; transfer rates are similar in urban and rural settings. Rural children have additional obstacles to care, especially in access to emergency mental health services. Programs to study and implement regionalization of care should consider diverse patient populations and target improvement in coordination of care, transfer times, and outcomes.

Original languageEnglish (US)
Pages (from-to)252-258
Number of pages7
JournalJournal of Rural Health
Issue number3
StatePublished - Oct 1 2014
Externally publishedYes


  • Access to care
  • Health disparities
  • Mental health
  • Policy
  • Utilization of health services

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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