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Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?
Etienne E Pracht1, Joseph J Tepas, Barbara Langland-Orban
1University of South Florida College of Public Health, Tampa, FL 33601, USA.
Insights
Seriously injured children treated at designated trauma centers (DTCs) show improved survival. Pediatric DTCs further reduce mortality, highlighting the need for specialized pediatric trauma care.
Area of Science:
- Pediatric critical care research
- Trauma surgery outcomes
- Public health policy in emergency medicine
Background:
- Serious pediatric trauma requires specialized care.
- Outcomes vary between trauma centers and general acute care hospitals.
Purpose of the Study:
- Compare survival rates for pediatric trauma patients treated at designated trauma centers (DTCs) versus non-trauma centers (NCs).
- Evaluate mortality differences between pediatric and non-pediatric DTCs.
Main Methods:
- Analysis of Florida inpatient discharge records (1995-2004) for children aged 0-19 years.
- Utilized instrumental variable analysis and bivariate probit modeling to assess mortality, controlling for triage bias.
- Compared outcomes for children treated at DTCs versus NCs, and within DTCs, pediatric vs. non-pediatric capabilities.
Main Results:
- Treatment at DTCs was associated with a 3.15% reduction in mortality for children aged 0-19 years (P < .0001).
- Treatment at designated pediatric DTCs, compared to non-pediatric DTCs, further reduced mortality by 4.84% (0-19 years) and 4.5% (0-15 years) (P < .001).
Conclusions:
- Optimal care for seriously injured children necessitates the comprehensive resources of a DTC.
- Pediatric-specific specialty support within DTCs is crucial for improving survival rates.
Objective:
The purposes of the study were to compare the survival associated with treatment of seriously injured patients with pediatric trauma in Florida at designated trauma centers (DTCs) with nontrauma center (NCs) acute care hospitals and to evaluate differences in mortality between designated pediatric and nonpediatric trauma centers.
Methods:
Trauma-related inpatient hospital discharge records from 1995 to 2004 were analyzed for children aged from 0 to 19 years. Age, sex, ethnicity, injury mechanism, discharge diagnoses, and severity as defined by the International Classification Injury Severity Score were analyzed, using mortality during hospitalization as the outcome measure. Children with central nervous system, spine, torso, and vascular injuries and burns were evaluated. Instrumental variable analysis was used to control for triage bias, and mortality was compared by probabilistic regression and bivariate probit modeling. Children treated at a DTC were compared with those treated at a nontrauma center. Within the population treated at a DTC, those treated at a DTC with pediatric capability were compared with those treated at a DTC without additional pediatric capability. Models were analyzed for children aged 0 to 19 years and 0 to 15 years.
Results:
For the 27,313 patients between ages 0 and 19 years, treatment in DTCs was associated with a 3.15% reduction in the probability of mortality (P < .0001, bivariate probit). The survival advantage for children aged 0 to 15 years was 1.6%, which is not statistically significant. Treatment of 16,607 children in a designated pediatric DTC, as opposed to a nonpediatric DTC, was associated with an additional 4.84% reduction in mortality in the 0- to 19-year age group and 4.5% in the 0 to 15 years group (P < .001, bivariate probit).
Conclusions:
Optimal care of the seriously injured child requires both the extensive and immediate resources of a DTC as well as pediatric-specific specialty support.
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