Effects of Trauma Center Consolidation on Pediatric Trauma at an Appalachian Pediatric Hospital

Area of Science:

• Pediatric Trauma Surgery
• Health Services Research
• Hospital Administration

Background:

• Hospital consolidation is a growing trend, with previous studies examining its impact on adult patient outcomes.
• Limited research exists on the effects of hospital consolidation specifically within pediatric trauma care systems.

Purpose of the Study:

• To evaluate pediatric trauma patient outcomes following the consolidation of two Level 1 Trauma Centers within a rural Appalachian health system.
• To identify changes in patient disposition, resource utilization, and costs after the trauma center merger.

Main Methods:

• Retrospective analysis of data from a Trauma Registry spanning October 2015 to September 2020.
• Key variables analyzed included Injury Severity Score (ISS), hospital and intensive care unit (ICU) length of stay, ventilator days, mortality, discharge disposition, consultations, and costs.
• Comparison of outcomes before and after the consolidation event.

Main Results:

• Despite an increase in the average Injury Severity Score (ISS) among pediatric trauma patients post-consolidation, in-patient outcomes such as mortality and length of stay showed no significant difference.
• Patients treated after consolidation were more frequently referred for orthopedic evaluation.
• An increase in the need for post-discharge outpatient care was observed in the post-consolidation cohort.

Conclusions:

• Pediatric trauma patient outcomes remained stable regarding in-patient metrics after the merger of two Level 1 Trauma Centers.
• The findings suggest that the trauma service may be evaluating a broader spectrum of injuries post-consolidation, necessitating increased specialized outpatient follow-up.
• Further research is needed to explore the long-term implications and cost-effectiveness of this expanded evaluation scope.