Mortality Among Injured Children Treated at Different Trauma Center Types

Abstract

Injured children treated at ATCs and MTCs had higher in-hospital mortality compared with those treated at PTCs. This association was most evident in younger children and remained significant in severely injured children. Quality improvement initiatives geared toward ATCs and MTCs are required to provide optimal care to injured children.

Association Between Trauma Center Type and Mortality Among Injured Adolescent Patients

“…Patients treated at PTCs were younger, more likely to be transferred from other hospitals, less severely injured, and had a different distribution of injury mechanisms. The demographic and injury severity differences are consistent with most previous studies including data from children of all ages 3,9,16,23 and those containing only adolescent data. 13,14 The patient population differences observed between those treated at PTCs and either ATCs or MTCs may be explained by either first-responder triage decision making or local triage criteria.…”

“…Previous studies examining the optimal trauma center type for children have mostly shown an outcome advantage for children treated at a PTC or MTC compared with those treated at an ATC. [3][4][5][6][7][8][9] Although a consensus is forming for the optimal treatment center for younger children, controversy still remains about the optimal location for treating injured adolescents. [10][11][12][13][14] Few studies have evaluated the outcome for adolescents at different trauma center types after injury.…”

“…Although patient demographics and injury patterns have been proposed as explanations for differences in mortality, these differences were not consistently observed even after controlling for patient and injury features. 3,4,6,8,9,15,16 The objectives of this article are to determine whether type of trauma center designation (PTC, MTC, or ATC) is associated with mortality among adolescent trauma patients in a sample obtained from the National Trauma Data Bank and to determine differences among patients presenting to different center types. A second objective was to determine the final discharge disposition of survivors at different center types.…”

Surgical intervention in pediatric trauma at a level 1 trauma hospital: a retrospective cohort study and report of cost data

“…1,2 The management of injured children continues to evolve, with the establishment of level 1 pediatric trauma centres 3 and centralization of care with involvement of multiple disciplines. 4,5 Given that the management of severely injured children requires coordinated care provided by multiple pediatric surgical subspecialties, 2,5,6 we sought to describe the frequency, timing, associated costs and surgical subspecialties involved in the management of pediatric trauma patients at a regional lead trauma hospital in Canada.…”

Helicopters and injured kids

“…Covariates included race, insurance status, Trauma Mortality Prediction Model (TMPM) predicted mortality, 27 admission hypotension, abnormal admission HR, abnormal admission RR, admission GCS, ICU admission, need for mechanical ventilation, urgent operation, occurrence of in-hospital complications, non-accidental trauma, and trauma center type (adult only level I/II, pediatric only level I/II, mixed adult/pediatric level I/II, non-level I/II center). Given recent evidence that trauma center type influences mortality in children, 28 interactions were tested between transport mode and trauma center type as well as trauma center level to determine if the effect of transport mode on survival differs across these factors. Discharge disposition models were also adjusted for presence of an extremity injury with abbreviated injury scale (AIS)>2 and presence of a spinal cord injury.…”