Faculty Collaboration Database

Impact of pediatric trauma centers on mortality in a statewide system. J Trauma 2000 Aug;49(2):237-45

Date

08/30/2000

Pubmed ID

10963534

DOI

10.1097/00005373-200008000-00009

Scopus ID

2-s2.0-0033811537 (requires institutional sign-in at Scopus site)   303 Citations

Abstract

BACKGROUND: Regional pediatric trauma centers (PTC) were established to optimize the care of injured children. However, because of the relative shortage of PTC, many injured children continue to be treated at adult trauma centers (ATC). As a result, a growing controversy has evolved regarding the impact of PTC and ATC on outcome for injured children.

METHODS: A retrospective analysis of 13,351 injured children entered in the Pennsylvania Trauma Outcome Study between 1993 and 1997 was conducted. Patients were stratified according to mechanism of injury, injury severity, specific organ injury, and type of trauma center: PTC; Level I ATC (ATC I); Level II ATC (ATC II); or ATC with added qualifications to treat children (ATC AQ). Mortality was the major outcome variable measured.

RESULTS: Most injured children were treated at a PTC or ATC AQ. The majority of children below 10 years of age were admitted to PTC. Patients treated at PTC and ATC had similar injury severity as determined by median Injury Severity Score, mean Revised Trauma Score, and Glasgow Coma Scale. Overall survival was significantly better at PTC and ATC AQ compared with ATC I and ATC II. Survival for head, spleen, and liver injuries was significantly better at PTC compared with ATC AQ, ATC I, or ATC II. Children who sustained moderate or severe head injuries were more likely to undergo neurosurgical intervention and have a better outcome when treated at a PTC. Despite similar mean Abbreviated Injury Scores for spleen and liver, significantly more children underwent surgical exploration (especially splenectomy) for spleen and liver injuries at ATC compared with PTC.

CONCLUSION: Children treated at PTC or ATC AQ have significantly better outcome compared with those treated at ATC. Severely injured children (Injury Severity Score > 15) with head, spleen, or liver injuries had the best overall outcome when treated at PTC. This difference in outcome may be attributable to the approach to operative and nonoperative management of head, liver, and spleen injuries at PTC.

Author List

Potoka DA, Schall LC, Gardner MJ, Stafford PW, Peitzman AB, Ford HR

Author

Laura Cassidy PhD Associate Dean, Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child Health Services
Child, Preschool
Craniocerebral Trauma
Female
Humans
Infant
Injury Severity Score
Liver
Male
Pennsylvania
Regional Medical Programs
Retrospective Studies
Spleen
Trauma Centers
Wounds, Nonpenetrating
Wounds, Penetrating