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Does shock index, pediatric age-adjusted predict mortality by trauma center type?
John R Austin1, Chaonan Ye, Moon O Lee
1From the Division of Pediatric Surgery, Department of Surgery (J.R.A., C.Y., S.D.C.) and Department of Emergency Medicine (M.O.L.), Stanford University School of Medicine, Stanford, California.
Insights
Pediatric trauma patients with elevated shock index, pediatric age-adjusted (SIPA) showed no difference in mortality across adult, mixed, or pediatric trauma centers. However, other factors suggest specialized care may optimize outcomes.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Health Services Research
Background:
- Pediatric trauma patients are treated in diverse settings: adult trauma centers (ATCs), mixed pediatric and ATCs (MTCs), and pediatric trauma centers (PTCs).
- The shock index, pediatric age-adjusted (SIPA) is a tool to identify severely injured children.
- Understanding outcomes based on trauma center type for high-risk pediatric patients is crucial.
Purpose of the Study:
- To compare mortality and hospital length of stay (LOS) among pediatric trauma patients with elevated SIPA (eSIPA) treated at ATCs, MTCs, and PTCs.
- To analyze secondary outcomes including splenectomy, CT chest scans, and laparotomy rates across different trauma center types.
Main Methods:
- A retrospective analysis of the 2013-2016 National Trauma Data Bank included pediatric patients (1-14 years) with eSIPA.
- Multivariable regression analyses were performed to compare outcomes, controlling for patient and hospital factors.
- Statistical significance was determined using an alpha level of 0.01.
Main Results:
- No significant difference in mortality was found among eSIPA patients across ATCs, MTCs, and PTCs, even for those with severe injuries (Injury Severity Score > 25).
- Splenectomy and computed tomography (CT) chest scan rates were significantly higher at ATCs and MTCs compared to PTCs.
- Laparotomy rates and hospital LOS did not differ significantly between trauma center types.
Conclusions:
- Elevated SIPA in pediatric trauma patients does not correlate with differential mortality based on trauma center type.
- Higher rates of specific interventions (splenectomy, CT chest scans) at ATCs and MTCs suggest potential differences in care patterns.
- Pediatric trauma centers may offer optimized care, warranting further investigation into specialized pediatric trauma management.
Background:
Pediatric trauma patients are treated at adult trauma centers (ATCs), mixed pediatric and ATCs (MTC), or pediatric trauma centers (PTCs). Shock index, pediatric age-adjusted (SIPA) can prospectively identify severely injured children. This study characterized the differences in mortality and hospital length of stay (LOS) among pediatric trauma patients with elevated SIPA (eSIPA) at different trauma centers types.
Methods:
Pediatric patients (1-14 years) were queried from the 2013 to 2016 National Trauma Data Bank. Patients with eSIPA were included for analysis. The primary outcome was mortality. Secondary outcomes included rates of splenectomy, computed tomography chest scans, laparotomy, and hospital LOS. Unadjusted frequencies and multivariable regression analyses were performed. An alpha level of 0.01 was used to determine significance.
Results:
Out of 189,003 pediatric trauma patients, 15,832 were included for analysis. After controlling for age, race, sex, payment method, Injury Severity Score, Glasgow Coma Scale score, hospital teaching status, and number of hospital beds, there was no significant difference in mortality among eSIPA patients at ATCs (odds ratio [OR], 0.753; p = 0.078) and MTCs (OR, 1.051; p = 0.776) when compared with PTCs. This remained true even among the most severely injured eSIPA patients (Injury Severity Score > 25). Splenectomy rates were higher at ATCs (OR, 3.234; p = 0.005), as were computed tomography chest scan rates (ATC OR, 4.423; p < 0.001; MTC OR, 6.070; p < 0.001) than at PTCs. There was a trend toward higher splenectomy rates at MTCs (OR, 2.910; p = 0.030) compared with PTCs, but this did not reach statistical significance. Laparotomy rates and hospital LOS were not significantly different.
Conclusion:
Among eSIPA pediatric trauma patients, there was no difference in mortality between trauma center types. However, other secondary findings indicate that specialty care at PTCs may help optimize the care of pediatric trauma patients.
Level Of Evidence:
Retrospective cohort study, level IV.
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