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Impact of pediatric trauma centers on mortality in a statewide system
D A Potoka1, L C Schall, M J Gardner
1Department of Surgery, University of Pittsburgh, Pennsylvania, USA.
Insights
Pediatric trauma centers (PTC) and adult trauma centers with pediatric qualifications (ATC AQ) offer better outcomes for injured children than standard adult trauma centers (ATC). Severely injured children with head, spleen, or liver trauma fare best at PTC.
Area of Science:
- Pediatric Trauma Care
- Trauma Surgery Outcomes
- Injury Epidemiology
Background:
- Regional pediatric trauma centers (PTC) were established to improve care for injured children.
- A shortage of PTC leads many children to be treated at adult trauma centers (ATC), creating controversy over optimal care settings.
- This study compares outcomes for pediatric trauma patients treated at different types of trauma centers.
Purpose of the Study:
- To compare the outcomes of injured children treated at pediatric trauma centers (PTC) versus various levels of adult trauma centers (ATC).
- To determine if specialized pediatric trauma care impacts survival and treatment approaches for specific injuries in children.
Main Methods:
- Retrospective analysis of 13,351 injured children from the Pennsylvania Trauma Outcome Study (1993-1997).
- Patients stratified by injury mechanism, severity, organ injury, and trauma center type: PTC, Level I ATC (ATC I), Level II ATC (ATC II), or ATC with added qualifications for children (ATC AQ).
- Mortality and specific injury outcomes were the primary outcome variables.
Main Results:
- Overall survival was significantly better at PTC and ATC AQ compared to ATC I and ATC II.
- Survival for head, spleen, and liver injuries was superior at PTC compared to all ATC types.
- Children with severe head injuries had better outcomes and higher rates of neurosurgical intervention at PTC.
Conclusions:
- Children treated at PTC or ATC AQ demonstrate significantly better outcomes than those treated at standard ATCs.
- Severely injured children with head, spleen, or liver injuries achieve the best outcomes at PTC.
- Differences in outcomes may stem from specialized operative and nonoperative management strategies employed at PTCs.
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.
