Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system

Abstract

Background:Previous studies have shown divergent results regarding the survival of injured children treated at pediatric trauma centers (PTC) and adult trauma centers (ATC).Aims:(1) To document, in a regionalized inclusive trauma system, at which level of trauma centers were the injured children treated and (2) to compare the in-hospital mortality over five levels of trauma care, ranging from pediatric level I trauma centers (PTC) to designated local trauma hospitals (level IV) for the whole study sample and for subgroups of severely injured children and head trauma.Materials and Methods:A retrospective analysis included data on 11,053 injured children (age ≤16 years) treated between April 1998 and March 2005 in 58 designated trauma hospitals in the province of Quebec, Canada. Multiple imputation was used to handle missing physiological data and multivariate logistic regression was used to compare mortality over levels of care.Results:PTC treated 52.2% of the children. Children treated at PTC were more often transferred from another hospital (73%) and were more severely injured. ATC level I, II, III and IV centers treated, respectively, 3.0%, 16.2%, 24.3% and 4.3% of children. Compared with children treated at a PTC, the risk of mortality was higher for children treated at each other ATC, i.e. level I (adjusted odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.3–7.5), level II (OR = 2.5; 95% CI: 1.3–5.0), level III (OR = 5.2; 95% CI: 2.1–13.1) and level IV (OR = 9.9; 95% CI: 2.4–41.3). Similar findings were observed among the subsamples of children who were more severely injured (Injury Severity Score >15) and who sustained head injuries.Conclusions:In our trauma system, PTC cared for more than half of the injured children and patients treated there have better survival than those treated at all other levels of ATC.

Epidemiology of paediatric trauma presenting to US emergency departments: 2006–2012

“…While several recent studies note that specialised paediatric trauma centres provide optimal care to injured children,28 29 most are treated at centres without such designation (and, with respect to our study, NEDS data do not specify paediatric trauma centres) [72]. Thus, understanding whether community trauma centres are indeed better equipped than non-trauma centres to treat severely injured children is key 30.…”

Association Between Trauma Center Type and Mortality Among Injured Adolescent Patients

“…This finding is similar to that of studies that evaluated mortality differences among children of all ages (including adolescents) and among younger children only. 3,4,6,7,21 Previous studies that have examined outcomes for only adolescents did not find mortality differences among center types. 13,14 Both studies were performed using state registry data (Ohio 14 and Pennsylvania…”

Pediatric Mortality andPreventable Death at a Mature Trauma Center

“…Several studies have attempted to determine which types of centers provide the best care to injured children (pediatric trauma centers v. adult trauma centers v. mixed trauma centers), however these studies use overall in-hospital mortality rates as a basis for comparison [5][6][7][8][9]. We believe that the PDR is a more appropriate area of focus as it quantifies the number of patients who died as a result of deficiencies in care.…”