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Association of transport time with adverse outcome in paediatric trauma
Helen Träff1, Lars Hagander1,2, Martin Salö1,2
1Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.
Insights
Longer transport times for critically injured children did not worsen outcomes like mortality or functional status. This suggests transport duration should not hinder centralizing pediatric trauma care. Further research is needed on prehospital care factors.
Area of Science:
- Pediatric trauma care
- Prehospital emergency medicine
- Trauma registry analysis
Background:
- The impact of prehospital transport duration on outcomes in pediatric trauma patients remains unclear.
- This study investigates the association between transport time and adverse outcomes in this vulnerable population.
Purpose of the Study:
- To evaluate the relationship between transport time (alarm to hospital arrival) and adverse outcomes in pediatric trauma patients in Sweden.
- To determine if longer transport times are associated with increased mortality, need for emergency interventions, or poor functional outcomes.
Main Methods:
- Retrospective analysis of prospectively collected data from the Swedish trauma registry (2012-2019).
- Inclusion criteria: children (<18 years) with major trauma (New Injury Severity Score > 15).
- Outcomes assessed: 30-day mortality, emergency interventions, and low functional outcome (Glasgow Outcome Scale 2-3).
- Multivariable regression analysis adjusted for patient, injury, and hospital characteristics.
Main Results:
- Among 597 patients, 30-day mortality was 9.8%, emergency interventions were needed in 34.7%, and low functional outcome occurred in 15.9%.
- Median transport time was 51 minutes.
- No significant association was found between longer transport time and adverse outcomes after adjustment for covariates.
- Treatment at a university hospital correlated with a reduced risk of 30-day mortality (OR 0.23).
Conclusions:
- Extended prehospital transport times were not associated with adverse outcomes in major pediatric trauma cases.
- Transport duration should not impede the centralization of pediatric trauma care.
- Future research should explore the influence of prehospital competence and other transport-related factors on patient outcomes.
Background:
It is unclear how the length of prehospital transport time affects outcome in paediatric trauma. This study evaluated the association of transport time from alarm to arrival at hospital with adverse outcome in paediatric trauma patients in Sweden.
Methods:
This was a retrospective study based on prospectively collected data from the Swedish trauma registry between 2012 and 2019 of children less than 18 years with major trauma (New Injury Severity Score (NISS) greater than 15). The primary outcome was 30-day mortality, and secondary outcomes were emergency interventions (e.g., chest tube or laparotomy) and low functional outcome (Glasgow Outcome Scale 2-3). Primary exposure was transport time from alarm to arrival at hospital. Co-variables in multivariable regressions were gender, age, ASA score before injury, injury intention, dominant injury type, NISS, Glasgow Coma Scale score, prehospital competence and hospital level.
Results:
Among 597 patients, 30-day mortality was 9.8 per cent, emergency interventions were performed in 34.7 per cent and low functional outcome was registered in 15.9 per cent. Median transport time was 51 (i.q.r. 37-68) minutes. After adjustment for patient, injury and hospital characteristics, no association between longer transport time and 30-day mortality, frequency of emergency interventions or lower functional outcome could be found. Treatment at a university hospital was associated with a lower risk for 30-day mortality (odds ratio 0.23 (95 per cent c.i. 0.08 to 0.68), P = 0.008).
Conclusion:
Longer transport time after major paediatric trauma was not associated with adverse outcome. Hence, it seems that longer transport distances should not be an obstacle against centralization of paediatric trauma care. Further studies should focus on the role of prehospital competence and other transport-associated parameters and their association with adverse outcome.
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