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Significant reduction in delayed diagnosis of injury with implementation of a pediatric trauma service
Joseph F Perno1, Jeff E Schunk, Kristine W Hansen
1Division of Pediatric Emergency Medicine, Department of Pediatrics, All Children's Hospital, St. Petersburg, FL, USA. jperno@pol.net
Insights
Implementing a dedicated pediatric trauma response team significantly reduced delayed diagnosis of injury (DDI) in children. This quality improvement initiative lowered the DDI rate by nearly 10-fold, enhancing patient care.
Area of Science:
- Pediatric trauma care
- Quality improvement in healthcare
- Injury diagnosis
Background:
- Delayed diagnosis of injury (DDI) in pediatric trauma patients indicates a failure in trauma care.
- The rate of DDI can serve as a metric for evaluating trauma care quality.
Purpose of the Study:
- To assess the incidence of DDI in admitted pediatric trauma patients treated by a designated trauma response team.
- To compare the DDI rate with the historical incidence before the team's implementation.
Main Methods:
- Analysis of prospectively gathered data from the Primary Children's Medical Center (PCMC) Trauma Database.
- Inclusion of all hospitalized pediatric trauma patients from 1997 to 2000.
- Comparison of DDI rates before and after the establishment of a trauma response team.
Main Results:
- A total of 3265 pediatric trauma patients were included in the study.
- The incidence of DDI decreased from 4.3% to 0.46% after implementing the trauma response team.
- Patients with DDI had more severe injuries, higher Injury Severity Scores, and longer hospitalizations.
Conclusions:
- The implementation of a dedicated trauma team and service significantly reduced the incidence of DDI in pediatric trauma patients.
- This demonstrates a successful quality improvement strategy in pediatric trauma care.
Background:
The occurrence of delayed diagnosis of injury (DDI) among pediatric trauma patients represents a breakdown in trauma care. Although some DDI may be unavoidable, the rate of DDI may be used as a measure of quality improvement.
Objective:
We sought to investigate DDI in admitted pediatric trauma patients while a designated pediatric trauma response team was used and compare this with the prior incidence of DDI (4.3%) before initiation of the response team.
Methods:
Primary Children's Medical Center (PCMC) is a regional tertiary pediatric trauma center. This analysis used the prospectively gathered PCMC Trauma Database, and included all hospitalized pediatric trauma patients from 1997 through 2000.
Results:
A total of 3265 patients were included; no patients were excluded. A DDI occurred in 15 (0.46%; 95% CI: 0.31, 0.79) trauma patients. The DDI patients were more severely injured with significantly higher Injury Severity Scores, lower TRISS Probability of Survival values, longer hospitalizations (P < or = 0.05, Mann-Whitney U), and were more frequently admitted to the PICU (P < or = 0.05, chi2) than the non-DDI patient population. In a previous study, our incidence of missed injury was 4.3% (50/1175; 95% CI: 3.3, 5.6); with implementation of a designated trauma response team and trauma service, the incidence of DDI was reduced nearly 10-fold to 0.46% (15/3265; 95% CI: 0.31, 0.79).
Conclusions:
Implementation of an effective trauma team and trauma service was associated with a significant reduction in DDI.