Facility Size and Risk Factors for Mortality in Pediatric Trauma

Abstract

Background Pediatric trauma outcomes can vary across facilities, yet evidence on the relationship between facility bed size and pediatric trauma outcomes has been mixed. We aimed to identify how facility bed size might modify the impact of patient-level risk factors on mortality in pediatric trauma. We hypothesized that patient-level risk factors would have a stronger association with mortality at smaller trauma centers, and a weaker association with mortality at larger centers. Methods We used deidentified data obtained from the 2017-2018 Trauma Quality Programs registry, including patients ages 0-18 years of age who were admitted to the hospital. The primary outcome was in-hospital mortality. Facility bed size was dichotomized as large (>600 beds) vs small/medium (≤600 beds). Sensitivity analyses used 200 and 400 beds as alternative cutoffs. Interaction between facility bed size and patient characteristics was assessed using unadjusted logistic regression, with statistically significant interactions entered in a final, fully adjusted model. Results The analysis included 171 810 patients (mean age 10 ± 5 years; 65%/35% male/female), including 28% treated in a large hospital and 1.2% who died during the hospitalization. Controlling for trauma center level (or subsetting to pediatric trauma centers only), larger bed size did not reduce mortality risk associated with patient characteristics such as injury mechanism, injury severity, or patient demographics. Conclusions Contrary to our hypothesis, greater facility bed size was not associated with reduced mortality risk associated with patient characteristics. Future studies are needed to identify hospital practices or characteristics that can attenuate the excess risk of known patient-level risk factors.

Pediatric vs Adult or Mixed Trauma Centers in Children Admitted to Hospitals Following Trauma

“…Among 6860 records identified in the databases, 5369 titles and abstracts were screened, and 212 manuscripts were assessed for eligibility, of which 56, with 286 051 total participants, were included in the review (eFigure 1 in eAppendix 2 in Supplement 1). Forty-four studies (79%) were published after 2010 (eTable 5 in Supplement 1).…”

“…Among 6860 records identified in the databases, 5369 titles and abstracts were screened, and 212 manuscripts were assessed for eligibility, of which 56, 4 , 8 , 12 , 13 , 14 , 18 , 19 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 with 286 051 total participants, were included in the review (eFigure 1 in eAppendix 2 in Supplement 1 ). Forty-four studies (79%) were published after 2010 (eTable 5 in…”

Prehospital time and mortality in pediatric trauma

“…However, we acknowledge that there are too few such centers in the United States to accommodate the volume of pediatric traumas, as compared to adult trauma centers. For example, only 72% of pediatric trauma patients in the United States have access to a verified pediatric trauma center accessible within 60 min by the air or ground transportation [ 24 ], and only 53% of pediatric trauma patients in the 2017–2018 TQIP registry received care in a pediatric-verified trauma center [ 25 ].…”