Trauma experts versus pediatric experts: comparison of outcomes in pediatric penetrating injuries

Miyata, Shin; Cho, Jayun; Lebedevskiy, Olga; Matsushima, Kazuhide; Bae, Esther; Bliss, David

doi:10.1016/j.jss.2016.09.040

Cited by 19 publications

(19 citation statements)

References 20 publications

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“…This same study reported those <5 years old may have superior functional outcomes when treated at a paediatric trauma centre. 12 Adolescents (10-24.99 years) who presented to a children's MTC had a lower ISS compared with adult and mixed MTCs. Previous trauma studies report a correlation between an increasing ISS and higher mortality.…”

Section: Original Researchmentioning

confidence: 96%

“…Some report higher mortality in adult and mixed MTCs compared with children's MTCs, while others report no association. [11][12][13] The primary aim of this study was to identify mortality rates for severely injured adolescents in England in different MTC types. The secondary aims were to describe length of stay (LoS), number of critical care days (intensive care unit (ICU) LoS), time to CT and the most senior clinician present at the initial resuscitation in MTC types.…”

Section: Original Researchmentioning

confidence: 99%

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Mortality in adolescent trauma: a comparison of children’s, mixed and adult major trauma centres

et al. 2021

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ObjectiveWe aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children’s and mixed).MethodsData were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012–2018), with adolescence defined as 10–24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn’s post-hoc analysis for pairwise comparison and χ2 test for categorical variables.Results21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children’s), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and ‘hospital ID’, resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children’s MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14–17.99 years old, those managed in a children’s MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children’s and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children’s MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children’s MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult).ConclusionsChildren’s MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.

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Section: Original Researchmentioning

confidence: 96%

Section: Original Researchmentioning

confidence: 99%

Mortality in adolescent trauma: a comparison of children’s, mixed and adult major trauma centres

et al. 2021

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“…It is not clear why there was no difference in ED mortality for the children with a penetrating mechanism but this finding is the same as the results of two prior studies. [ 3 8 ] Hall et al . reported better outcomes for children with blunt injuries treated at PTCs but concluded that older children with penetrating injuries had equivalent mortality whether treated in an adult or pediatric center.…”

Section: Discussionmentioning

confidence: 99%

“…However, whether PTCs actually improve outcomes have been controversial. [ 1 2 3 4 5 6 7 8 ] Some adult trauma centers (ATCs) have reported pediatric survival rates equivalent to publish national standards. [ 2 9 ] However, interpretation of these investigations is limited due single-center data that used trauma and injury severity score (ISS) methodology to compare their pediatric outcomes to the major trauma outcomes study in which only 10.8% of the patient population included children <15 years of age.…”

Section: Introductionmentioning

confidence: 99%

Pediatric mortality at pediatric versus adult trauma centers

Khalil

Alawwa

Pinto

et al. 2021

J Emerg Trauma Shock

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“…6 While there is debate over the value of dedicated pediatric trauma centers, 7–9 there is evidence that treatment at these centers is associated with lower mortality rates. 10–12 Further, there is often geographic separation between pediatric trauma resources, as these facilities tend to be located in metropolitan areas.…”

Section: Introductionmentioning

confidence: 99%

State-level geographic variation in prompt access to care for children after motor vehicle crashes

Wolf

Chowdhury

Tweed

et al. 2017

Journal of Surgical Research

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Background Motor vehicle crashes (MVCs) are a principal cause of death in children; fatal MVCs and pediatric trauma resources vary by state. We sought to examine state-level variability in and predictors of prompt access to care for children in MVCs. Materials and Methods Using the 2010–2014 Fatality Analysis Reporting System, we identified passengers <15y involved in fatal MVCs (crashes on U.S. public roads with ≥1 death, adult or pediatric, within 30d). We included children requiring transport for medical care from the crash scene with documented time of hospital arrival. Our primary outcome was transport time to first hospital, defined as >1h or ≤1h. We used multivariable logistic regression to establish state-level variability in the percentage of children with transport time >1h, adjusting for injury severity (no injury, possible injury, suspected minor injury, suspected severe injury, fatal injury, unknown severity), mode of transport (Emergency Medical Services (EMS) air, EMS ground, non-EMS), and rural roads. Results We identified 18,116 children involved in fatal MVCs from 2010–2014; 10,407 (57%) required transport for medical care. Median transport time was 1h (IQR: [1,1]; range: [0,23]). The percent of children with transport time >1h varied significantly by state, from 0% in several states to 69% in New Mexico. Children with no injuries identified at the scene and crashes on rural roads were more likely to have transport times >1h. Conclusions Transport times for children after fatal MVCs varied substantially across states. These results may inform state-level pediatric trauma response planning.

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Trauma experts versus pediatric experts: comparison of outcomes in pediatric penetrating injuries

Cited by 19 publications

References 20 publications

Mortality in adolescent trauma: a comparison of children’s, mixed and adult major trauma centres

Mortality in adolescent trauma: a comparison of children’s, mixed and adult major trauma centres

Pediatric mortality at pediatric versus adult trauma centers

State-level geographic variation in prompt access to care for children after motor vehicle crashes

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