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Differences in survival outcome for severely injured paediatric trauma by type of trauma centre
Rebecca J Mitchell1, Kate Curtis2, Luke Testa1
1Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Insights
Severely injured children treated at paediatric trauma centres (PTCs) had significantly better survival rates than those treated at adult trauma centres (ATCs). This highlights the importance of specialized paediatric trauma care for improving outcomes in critically injured children.
Area of Science:
- Trauma Surgery
- Paediatric Emergency Medicine
- Public Health Policy
Background:
- Paediatric trauma care effectiveness is debated, with uncertainty regarding survival advantages of specialized paediatric trauma centres (PTCs) versus adult trauma centres (ATCs).
- Optimal management strategies for severely injured children are crucial for improving survival and long-term outcomes.
- Existing data on trauma centre type and paediatric mortality requires further investigation.
Purpose of the Study:
- To examine the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients.
- To determine if treatment at a PTC confers a survival advantage compared to an ATC for children aged 15 years and younger.
- To inform policy and practice regarding paediatric trauma care delivery.
Main Methods:
- Retrospective analysis of paediatric patient data (aged ≤15 years) from the New South Wales Trauma Registry (2009-2014).
- Inclusion criteria: severely injured children (Injury Severity Score > 12).
- Logistic regression analysis to assess the relationship between trauma centre type and in-hospital mortality.
Main Results:
- A total of 1230 severely injured children were included; 81% received care at a PTC.
- Children treated at a Level 1 ATC had 6.1 times higher odds of in-hospital mortality compared to those treated at a PTC.
- Higher ICU admission rates were observed at PTCs (50%) compared to Level 1 ATCs (23.9%).
Conclusions:
- Paediatric trauma centres provide a significant survival advantage for severely injured children compared to Level 1 adult trauma centres.
- Findings underscore the critical role of specialized paediatric trauma care systems.
- Further prospective studies on care processes are recommended to optimize paediatric trauma management.
Aim:
Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured children over treatment at adult trauma centres (ATCs) remains inconclusive. This study examines the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients in New South Wales, Australia.
Methods:
A retrospective examination of paediatric patient characteristics (aged ≤15 years), treatment and injury outcome was conducted using data from the New South Wales Trauma Registry for 2009-2014. Logistic regression was used to examine the association of in-hospital mortality and type of trauma centre.
Results:
There were 1230 children who were severely injured (i.e. Injury Severity Score; ISS > 12) and 81.0% received definitive care at a PTC. Two-thirds were male, 37.8% were aged 11-15 years and falls represented 32.0% of the injuries. Almost half (48.9%) the injured children had an ISS between 16 and 24, 31.9% between 25 and 39 and 3.8% an ISS between 40 and 75. The mean and median hospital length of stay was 17.5 and 5 days, respectively. Fifty percent of children that received definitive care at a PTC were admitted to an ICU compared to 23.9% at a Level 1 ATC. There were 119 (9.7%) in-hospital deaths. Children aged ≤15 years who were treated at a Level 1 ATC had 6.1 times higher odds of not surviving their injuries than if treated at a PTC.
Conclusion:
Children who received definitive care at a PTC had a survival advantage compared to those treated at a Level 1 ATC. Prospectively examining the processes of care for severely injured children may assist in identification of quality and system changes required to ensure optimal trauma care within the health-care system.
