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The effects of regionalization of pediatric trauma care in the Netherlands: a surveillance-based before-after study
Loes Janssens1, Herman R Holtslag, Ed F van Beeck
1Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Regionalization of Dutch pediatric trauma care significantly lowered in-hospital mortality for adolescents. This improvement in trauma care was not linked to changes in patient referral patterns.
Area of Science:
- Pediatric trauma care systems
- Public health policy
- Injury epidemiology
Background:
- Systemic changes in pediatric trauma care aim to decrease childhood injury mortality.
- The Netherlands implemented a regionalized trauma care system in 1999/2000.
- Evaluating the impact of this regionalization on referral patterns and mortality is crucial.
Purpose of the Study:
- To assess the effects of trauma care regionalization on referral behavior and in-hospital mortality in children.
- To compare outcomes before (1996-1998) and after (2001-2006) the implementation of the Dutch regionalized trauma care system.
Main Methods:
- A surveillance-based before-and-after study design was employed.
- Data included all children (0-18 years) discharged from hospitals in the
- Central Netherlands
- trauma region.
- In-hospital mortality rates and referral behaviors were analyzed pre- and post-regionalization.
Main Results:
- A total of 21,585 children were analyzed, with a mean age of 9.6 years and mean Injury Severity Score (ISS) of 4.3.
- Post-regionalization, a lower mean ISS and shorter mean length of stay were observed.
- In-hospital mortality significantly decreased for adolescents (13-18 years) (SMR 0.64) after adjusting for ISS, but not for younger children (0-12 years).
- No significant changes in referral behavior were detected for either age group.
Conclusions:
- Regionalization of trauma care in the Netherlands has led to reduced in-hospital mortality among adolescents.
- The observed mortality reduction in adolescents was not attributable to changes in referral behavior.
- Further research may be needed to understand the specific factors driving improved outcomes in adolescent trauma patients.
Background:
System changes in pediatric trauma care may reduce childhood injury mortality. The Dutch system of trauma care has been regionalized in 1999/2000. We evaluated changes in referral behavior and in-hospital mortality before and after regionalization of trauma care in the Netherlands.
Methods:
A surveillance-based before-after study was performed on all children aged up to 18 years that were discharged from one of the hospitals of the trauma care region "Central Netherlands" between 1996 and 1998 and between 2001 and 2006. The in-hospital mortality rate and referral behavior was compared before (1996-1998) and after (2001-2006) regionalization of trauma care in the Netherlands.
Results:
A total of 21,585 children were included, with a mean (SD) age of 9.6 (5.5) years and a mean (SD) Injury Severity Score (ISS) of 4.3 (4.4). After regionalization, the mean ISS was lower (p = 0.000), and the mean length of stay was lower (p = 0.000). The in-hospital mortality rate was significantly lower for the adolescent group (age, 13-18 years; n = 7,846; standardized mortality ratio, 0.64; 95% confidence interval, 0.34-0.93) after correction for the ISS. No changes were found for the younger children (age, 0-12 years; n = 13,739). No significant differences were found in referral behavior for both age categories.
Conclusion:
Regionalization of trauma care in the Netherlands reduced the in-hospital mortality rates for adolescents in the last decade. However, this reduction was not caused by a change in referral behavior.
Level Of Evidence:
Therapeutic study, level IV.