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Prehospital Transport Time and Outcomes for Pediatric Trauma: A National Study
Kendall J Burdick1, Aixa Perez Coulter2, Michael Tirabassi3
1T.H. Chan School of Medicine, Worcester, Massachusetts; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Insights
The "Golden Hour" of prehospital transport for pediatric trauma patients did not significantly impact survival rates. However, longer transport times were associated with extended hospital stays, highlighting the need for improved access and readiness in pediatric emergency care.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Public Health
Background:
- The
- Golden Hour
- concept suggests optimal survival for trauma patients within 60 minutes of injury.
- Evidence supporting this for pediatric trauma is limited.
- This study examines national trends in prehospital transport times and outcomes for pediatric trauma.
Purpose of the Study:
- To analyze national data on prehospital transport times for pediatric trauma patients.
- To investigate the association between transport time (within or exceeding 60 minutes) and patient survival.
- To explore the relationship between transport duration and length of hospital stay, adjusting for injury severity.
Main Methods:
- Retrospective cohort study of pediatric trauma patients (<15 years) transported by emergency medical services between 2017-2019.
- Transport time (≤60 min vs. >60 min) was the primary exposure variable.
- Analyses adjusted for Injury Severity Score (ISS); statistical comparisons included t-tests, Mann-Whitney U-tests, and Chi-Square tests.
Main Results:
- A total of 54,489 pediatric trauma patients were included; 62.2% had transport times under 60 minutes.
- Overall mortality was 1.6%, with variations based on trauma type (blunt vs. penetrating).
- Transport time under 60 minutes was not substantially associated with survival but was linked to shorter hospital stays for both blunt and penetrating trauma.
Conclusions:
- Prehospital transport within the
- Golden Hour
- did not demonstrate a significant impact on pediatric trauma survival.
- Transport times exceeding 60 minutes were associated with longer hospital lengths of stay, independent of injury severity.
- Continued efforts to enhance access to care and pediatric readiness in emergency medical services are crucial for optimizing trauma outcomes.
Introduction:
Historically, emergency medical services have aimed to deliver trauma patients to definitive care within the 60 min (min) "Golden Hour" to optimize survival. There is little evidence to support or refute this for pediatric trauma. The objective of this investigation was to describe national trends in prehospital transport time, in relation to the "Golden Hour," and pediatric trauma outcomes.
Methods:
Retrospective cohort study of patients (<15 y old) receiving emergency medical services trauma transport between 2017 and 2019. Transport time (less than or greater than 60 min) was the exposure variable, and analyses were adjusted for injury severity score (ISS). Continuous variables with a normal distribution were compared by t-test was and skewed variables were compared by Mann-Whitney U-test. Categorical variables were compared by Chi-Square test.
Results:
54,489 patients met our criteria: 49,628 blunt and 4861 penetrating. Most patients (62.2%) had transport times less than 60 min: 30,389 (61.2%) blunt and 3479 (71.6%) penetrating. The overall mortality rate was 1.6%, 1.2% for blunt and 5.5% for penetrating. For blunt trauma, mortality was higher for transport times less than 60 min (1.5%). For penetrating trauma, mortality was lower for transport times less than 60 min (0.7%). Mean ISS was greater for blunt (7.9) compared to penetrating trauma (7.1), and greater for both trauma types with transport times less than 60 min. For both trauma types, mean length of stay was significantly longer for transport times greater than 60 min, when adjusting for ISS (P < 0.001).
Conclusions:
We did not find evidence that prehospital transport within the "Golden Hour" had a substantial association with survival, though it may be associated with length of stay. There are many factors contributing to trauma outcomes, so efforts should continue to expand access and pediatric readiness.
