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What Makes a Trauma Patient "Pediatric"? Survey of Providers' Admission Decision Making for Pediatric Trauma Patients
Samir M Fakhry1, Gina M Berg, Nina Y Wilson
1Center for Trauma and Acute Care Surgery Research, HCA Healthcare, Clinical Services Group, Nashville, Tennessee (Drs Fakhry, Shen, Garland, and Watts, Mss Wilson and Morse, and Mr Wyse); Trauma Services, Wesley Medical Center, Wichita, Kansas (Dr Berg); Trauma Services, Mission Hospital, Asheville, North Carolina (Dr Slivinski and Ms Franklin); Trauma Services, Grand Strand Medical Center, Myrtle Beach, South Carolina (Mr Worthley and Dr Rhodes); Office of Research Oversight, Chippenham Hospital, Richmond, Virginia (Ms Brady); Department of Trauma and Surgical Critical Care (Dr Dunne) and Trauma Services (Ms Palladino), Memorial Health University Medical Center, Savannah, Georgia; and Pediatric Trauma, Medical City Children's Hospital, Dallas, Texas (Ms Turner).
Insights
Pediatric trauma patient admission practices lack a consistent age cutoff, leading to variability in care. Policies should be evidence-based, not based on tradition or preference.
Area of Science:
- Trauma Surgery
- Pediatric Care
- Healthcare Policy
Background:
- Many pediatric trauma patients are not treated in specialized pediatric facilities.
- This necessitates admission decisions to either pediatric or adult units in general trauma centers.
- Inconsistent practices in pediatric trauma admission may exist across different centers.
Purpose of the Study:
- To describe current practices in making admission decisions for pediatric trauma patients.
- To identify common age cutoffs and the rationale behind them.
- To highlight variability in pediatric trauma patient placement.
Main Methods:
- An email survey was distributed to members of trauma surgery and nursing professional organizations.
- Survey questions addressed pediatric age cutoffs, institutional placement decisions, and factors influencing placement.
- Data were collected from 313 survey responses across different types of trauma facilities.
Main Results:
- The mean age cutoff for pediatric trauma admission was 16.6 years, with 18 and 15 years being the most common cutoffs.
- Rationales for age cutoffs were primarily "institutional experience/tradition" (44.4%) and "physician preference" (28.4%).
- Significant variability in admission practices was observed between and within different facility types.
Conclusions:
- No universally accepted age cutoff exists for distinguishing pediatric from adult trauma patients for admission.
- Current pediatric trauma admission thresholds rely heavily on subjective criteria like tradition and preference.
- Institutions need to develop objective, evidence-based policies for pediatric patient placement in trauma care.
Background:
Only a fraction of pediatric trauma patients are treated in pediatric-specific facilities, leaving the remaining to be seen in centers that must decide to admit the patient to a pediatric or adult unit. Thus, there may be inconsistencies in pediatric trauma admission practices among trauma centers.
Objective:
Describe current practices in admission decision making for pediatric patients.
Methods:
An email survey was distributed to members of three professional organizations: The American Association for the Surgery of Trauma, Society of Trauma Nurses, and Pediatric Trauma Society. The survey contained questions regarding pediatric age cutoffs, institutional placement decisions, and scenario-based assessments to determine mitigating placement factors.
Results:
There were 313 survey responses representing freestanding children's hospitals (114, 36.4%); children's hospitals within general hospitals (107, 34.2%), and adult centers (not a children's hospital; 90, 28.8%). The mean age cutoff for pediatric admission was 16.6 years. The most reported cutoff ages were 18 years (77, 25.6%) and 15 years (76, 25.2%). The most common rationales for the age cutoffs were "institutional experience/tradition" (139, 44.4%) and "physician preference" (89, 28.4%).
Conclusion:
There was no single widely accepted age cutoff that distinguished pediatric from adult trauma patients for admission placement. There was significant variability between and within the types of facilities, with noted ambiguity in the definition of a "pediatric" patient. Thresholds appear to be based primarily on subjective criteria such as traditions or preferences rather than scientific data. Institutions should strive for objective, evidence-based policies for determining the appropriate placement of pediatric patients.
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