Does shock index, pediatric age-adjusted predict mortality by trauma center type?

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.