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Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients
Jessica H Rubens1, Omar Z Ahmed2, Gayane Yenokyan3
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Pediatric trauma patients arriving by self-transport are less likely to receive trauma team activation, despite potential for severe injuries. This underutilization may lead to delayed care for these children.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Health Services Research
Background:
- Injured children arriving via self-transport to emergency departments may face care delays.
- Understanding differences between self-transport and Emergency Medical Services (EMS) arrivals is crucial for pediatric trauma care.
Purpose of the Study:
- To compare demographics, clinical characteristics, and trauma activation status.
- To investigate disparities in care for admitted pediatric trauma patients based on transport method.
Main Methods:
- Retrospective cohort study at two Level I pediatric trauma centers.
- Inclusion criteria: patients <15 years old with blunt or penetrating injury.
- Analysis included univariate and multivariate logistic regression.
Main Results:
- 40.1% of 1161 pediatric trauma patients arrived by self-transport.
- Self-transport patients had lower rates of abnormal Glasgow Coma Scale and Injury Severity Score.
- Trauma activation was significantly less frequent in self-transport patients (2.4% vs. 86.2%).
- Self-transport arrival was associated with longer Emergency Department Length of Stay.
Conclusions:
- Nearly half of pediatric trauma admissions arrive by self-transport.
- Trauma team activation is underutilized in self-transport pediatric trauma patients.
- Further investigation is needed to optimize care for self-transported pediatric trauma patients.
Background:
Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS).
Materials And Methods:
We performed a retrospective cohort study at two level I pediatric trauma centers.
Inclusion Criteria:
<15 y old with blunt or penetrating injury. We used univariate and multivariate logistic regression analyses to determine associations between trauma activation, ED length of stay (LOS), and hospital LOS with demographic and clinical characteristics.
Results:
We identified 1161 patients: 40.1% arrived by self-transport and 59.9% by EMS. Self-transport patients were less likely to have an abnormal Glasgow Coma Scale score < 15 (2.1% versus 22.0%, P < 0.001) and Injury Severity Score > 15 (2.4% versus 11.7%, P < 0.001). Trauma activation was initiated in 52.5% of patients, occurring less often in self-transport than EMS patients (2.4% versus 86.2%, P < 0.001). Trauma activation rate was negatively associated with arrival by self-transport (odds ratio [OR] 0.001, 95% CI 0.00-0.003), positively associated with Glasgow Coma Scale <15 (OR 25.9, 95% CI 6.6-101.2) and site (OR 15.4, 95% CI 6.3-37.5) but not with Injury Severity Score >15 (OR 2.8, 95% CI 0.8-9.2). Self-transport arrival was associated with longer ED LOS (estimated regression slope 0.47, 95% CI 0.13-0.82).
Conclusions:
Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.
