The pediatric trauma center and the inclusive trauma system

Murphy, Emily E. K.; Murphy, Stephen; Cipolle, Mark; Tinkoff, Glen

doi:10.1097/ta.0000000000000610

Cited by 26 publications

(12 citation statements)

References 11 publications

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“…As shown in Table 2, tertiary centers had a higher percentage of patients with an ISS ≥ 16 than noncenter hospitals during every period of the study. These results are similar to the results of previous studies [11, 12]. The well-established infrastructure, facilities for immediate resuscitation and angiography, 24-h availability of the ICU and confidence of the trauma team might be influencing factors of this result [13].…”

Section: Discussionsupporting

confidence: 90%

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Liao

et al. 2019

Scand J Trauma Resusc Emerg Med

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BackgroundThe long-term treatment trends of splenic injuries can provide guidance when treating trauma patients. The nonoperative management (NOM) of splenic injuries was introduced in early 1989. After decades of development, it has proven to be safe and is now the primary treatment choice worldwide. However, there remains a lack of nationwide registry data to support the feasibility and efficiency of NOM.MethodsWe used the Taiwan National Health Insurance Research Database to conduct a whole population-based cohort study. Patients admitted with blunt splenic injuries from 2002 to 2013 were identified. Demographic data, management methods, associated injuries, comorbidities and outcome parameters were collected. Patients were divided into 2 groups by the type of admitting institution: a tertiary center or a non-center hospital. We also used 4 years as an interval to analyze the changes in epidemiological data and treatment trends. Comparisons of the results of NOM and surgical management were also performed.ResultsA total of 12,455 patients were admitted with blunt splenic injuries between 2002 and 2013. Among the 11,551 patients treated in a single hospital after admission, patients underwent NOM more frequently at tertiary centers than at non-center hospitals (64.6% vs 50.3%). During the 12-year study period, the NOM rate increased from 56 to 73% in tertiary centers, while in noncenter hospitals, the rate only increased from 43 to 58%. The mortality rate decreased in tertiary centers from 8.9 to 7.2%, with no apparent change in noncenter hospitals. Complications occurred more frequently in the surgical management group.ConclusionThere is a trend toward the use of NOM for blunt splenic injury treatments, and the outcomes from the NOM groups were not inferior to those of the operation group. In addition, tertiary centers performed more NOM than did non-center hospitals and better met the international consensus.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0578-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Liao

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…Therefore, CT scan should not be the only factor guiding the diagnostic process; and some authors use this argument to avoid imaging in a stable patient altogether. Surprisingly, several studies have shown that adherence to APSA guidelines is low in non-pediatric trauma centers [ 145 , 162 , 168 – 172 ]. Pediatric trauma patients treated in dedicated centers were demonstrated to have higher probability to undergo NOM than those treated in adult trauma centers [ 145 , 162 , 168 – 170 ].…”

Section: Pediatric Patientsmentioning

confidence: 99%

“…Surprisingly, several studies have shown that adherence to APSA guidelines is low in non-pediatric trauma centers [ 145 , 162 , 168 – 172 ]. Pediatric trauma patients treated in dedicated centers were demonstrated to have higher probability to undergo NOM than those treated in adult trauma centers [ 145 , 162 , 168 – 170 ]. Mooney et al and Todd et al demonstrated that children with splenic injury have a greater chance to undergo splenectomy or laparotomy in general if treated in an adult trauma center [ 171 , 173 ].…”

Section: Pediatric Patientsmentioning

confidence: 99%

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

et al. 2017

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Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

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“…Injury is a leading cause of death among the young everywhere in the world and the top global killer of adolescents (100). Findings from high-income countries suggest that dedicated systems of care for injured children can avert deaths and disability (72,76). In LMICs, pediatric-specific trauma care resources and expertise are more often deficient than those for general trauma care (2,11,75); planning and organizing care for injured children should be a priority area for research and system development, given the large burden of pediatric injury in LMICs.…”

Section: Wwwannualreviewsorg • the Impact Of Trauma Care Systems Inmentioning

confidence: 99%

The Impact of Trauma Care Systems in Low- and Middle-Income Countries

Reynolds

Stewart

Drewett

et al. 2017

Annu. Rev. Public Health

144

120

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Injury is a leading cause of death globally, and organized trauma care systems have been shown to save lives. However, even though most injuries occur in low-and middle-income countries (LMICs), most trauma care research comes from high-income countries where systems have been implemented with few resource constraints. Little context-relevant guidance exists to help policy makers set priorities in LMICs, where resources are limited and where trauma care may be implemented in distinct ways. We have aimed to review the evidence on the impact of trauma care systems in LMICs through a systematic search of 11 databases. Reports were categorized by intervention and outcome type and summarized. Of 4,284 records retrieved, 71 reports from 32 countries met inclusion criteria. Training, prehospital systems, and overall system organization were the most commonly reported interventions. Quality-improvement, costing, rehabilitation, and legislation and governance were relatively neglected areas. Included reports may inform trauma care system planning in LMICs, and noted gaps may guide research and funding agendas.

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The pediatric trauma center and the inclusive trauma system

Abstract: Therapeutic study, level IV; epidemiologic study, level III.

Cited by 26 publications

References 11 publications

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

The Impact of Trauma Care Systems in Low- and Middle-Income Countries

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