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Impact of operative intervention delay on pediatric trauma outcomes
Giana H Davidson1, Ronald V Maier, Saman Arbabi
1Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA. ghd@u.washington.edu
Insights
Early intervention for pediatric trauma patients with traumatic brain or solid organ injuries is linked to shorter hospital stays. Timely intracranial pressure monitoring and abdominal operations improve outcomes for survivors.
Area of Science:
- Pediatric Trauma Surgery
- Neurocritical Care
- Surgical Quality Indicators
Background:
- Pediatric trauma care quality indicators are crucial for reducing mortality and disability.
- Hypothesized that timing of interventions for traumatic brain injury (TBI) and solid organ injury (SOI) impacts outcomes.
- Key interventions include craniotomy, intracranial pressure (ICP) monitoring, and abdominal operations.
Purpose of the Study:
- To evaluate the association between the timing of specific surgical interventions and patient outcomes in pediatric trauma.
- To determine if early interventions correlate with reduced mortality, shorter hospital stays, and decreased need for discharge assistance.
Main Methods:
- Retrospective cohort study utilizing the National Trauma Data Bank.
- Included 99,513 pediatric patients with trauma.
- Therapeutic study, level III evidence.
Main Results:
- Early ICP monitor placement (within 4 hours) did not affect mortality but shortened hospital and ICU stays for survivors.
- Early craniotomy (within 4 hours) was associated with increased mortality; however, for survivors, it led to shorter overall and ICU stays.
- Early abdominal operations for solid organ injuries also correlated with shorter hospital and ICU stays for survivors.
Conclusions:
- Early surgical intervention for pediatric trauma patients who survive their initial operation is associated with reduced length of stay.
- Timely ICP monitoring and abdominal operations show benefits in survivors of TBI and SOI, respectively.
- Focusing on early intervention for survivors can optimize resource utilization and patient recovery.
Background:
Establishing quality indicators is an essential step in improving mortality and disability among pediatric patients with trauma. We hypothesized that timing of craniotomy, intracranial pressure (ICP) monitoring for traumatic brain injury, and abdominal operation for solid organ injury correlates with a reduced risk of death, shorter stay, and reduced risk of requiring assistance at discharge.
Methods:
This was a retrospective cohort study of 99,513 pediatric patients with trauma, using the National Trauma Data Bank.
Results:
For patients who had an ICP monitor placed within 4 hours compared with those whose ICP monitor was delayed, there was no difference in mortality; however, there was a shorter stay in the hospital (relative risk [RR], 0.84; 95% confidence interval (CI), 0.72-0.97) and in the intensive care unit (ICU) (RR, 0.76; 95% CI, 0.66-0.86) in those that survived to discharge. Patients who had craniotomy within 4 hours had higher mortality (RR, 1.98; 95% CI, 1.11-3.51) compared with those that were delayed. After excluding those that died, there was a shorter overall stay (RR, 0.69; 95% CI, 0.59-0.81) and ICU stay (RR, 0.69; 95% CI, 0.57-0.83). Similar length of stay results were seen in pediatric patients with solid organ injuries. Excluding those that died, length of stay (RR, 0.58; 95% CI, 0.47-0.73) and ICU stay (RR, 0.52; 95% CI, 0.37-0.74) were shorter.
Conclusion:
Early intervention in those who survive their initial operation is associated with shorter ICU and hospital stay for traumatic brain and solid organ injuries.
Level Of Evidence:
Therapeutic study, level III.
