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Pediatric trauma systems: critical distinctions
1Department of Surgery, School of Medicine, Oregon Health Sciences University, Portland 97201-3098, USA.
Insights
Evidence is limited on whether pediatric trauma centers improve care for injured children. A statewide trauma system may reduce mortality for seriously injured children, but more research is needed.
Area of Science:
- Pediatric Trauma Care
- Public Health
- Emergency Medicine
Background:
- Injured children constitute 25% of US trauma patients, requiring specialized care.
- Pediatric trauma centers and trauma systems aim to improve outcomes for these patients.
Purpose of the Study:
- To evaluate existing evidence on the impact of pediatric trauma centers, trauma centers with pediatric commitment, and trauma systems on the care of injured children.
Main Methods:
- Systematic review of published literature evaluating pediatric trauma centers, trauma centers with pediatric commitment, or trauma systems.
- Studies categorized by methodology: panel studies, trauma registry studies, and population-based studies.
Main Results:
- Limited population-based studies (2 of 18) assessed trauma center/system impact on children.
- One study found no improved survival with a trauma center; another indicated a statewide trauma system reduced mortality in severely injured children.
- A third study suggested urban trauma centers improved survival rates for injured children.
Conclusions:
- Further research is required to confirm the benefits of trauma systems for pediatric outcomes.
- Injury prevention strategies are crucial for improving future pediatric injury outcomes.
Background:
Injured children represent 25% of all injured patients in the United States and have unique needs that may require treatment at a pediatric trauma center or a trauma center with pediatric commitment. This work attempts to determine if there is existing evidence that pediatric trauma centers, trauma centers with pediatric commitment, or trauma systems have improved the care of injured children.
Methods:
Published literature evaluating the impact on injured children of pediatric trauma centers, trauma centers with pediatric commitment, or trauma systems was reviewed. The studies were divided by the methodology used for evaluation: panel studies, trauma registry studies, and population-based studies.
Results:
Of the 18 studies reviewed, only 2 population-based studies evaluated the impact of trauma centers or systems on children. One found that a trauma center did not improve the injured child's risk of death. The other found that a statewide trauma system improved the risk of death in seriously injured children. A third population-based study found improved risk of death if the child was treated at an urban trauma center.
Conclusion:
Further analysis is necessary to demonstrate whether trauma systems make a difference in pediatric outcome. Injury prevention will have the greatest impact on future pediatric injury outcomes.