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Purpose: To identify the characteristics at triage of high acuity pediatric patients who presented to community emergency departments and determine predictors for those who require transfer to a tertiary care pediatric center.

Patients and methods: We conducted a retrospective study of all pediatric Canadian Triage and Acuity Scale (CTAS) I patients presenting to five semirural hospital sites from January to December 2018. Univariate tests were used to identify significant predictors for transfer based on age, gender, Pediatric Early Warning Score (PEWS) score and presenting complaint. A multivariate model was developed based on backward selection from the significant factors from the univariate analysis to identify predictors for transfer.

Results: There were 1,137 subjects with an average age of 5.08 years (SD: 5.03) of whom, 559 (49.2%) were males. Sixty patients (5.3%) were transferred to a tertiary care center (60.9% <4 years). A PEWS score ≥3 (OR 3.005, 95% CI 1.623–5,563), presenting with trauma (OR 6.617, 95% CI 2.820–15-531), mental health issues (OR 5.131, 95% CI 1.444–18.232), or neurological issue (OR 3.057, 95% CI 1.355–6.896) were associated with transfer. Patients with fever (OR 0.113, 95% CI 0.031–0.407) and respiratory symptoms (OR 0.345, 95% CI 0.142–0.840) were less likely to be transferred.

Conclusion: Predictors of transfer from a community hospital to a pediatric tertiary care center were a PEWS score ≥3, trauma patients, those presenting with mental health issues, and patients with neurological symptoms. Early recognition can facilitate quicker transfer of these high acuity patients requiring tertiary care management.

Keywords: pediatric, transfer, high acuity