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Improved outcomes for severely injured children in designated pediatric trauma centers in the Netherlands
Sem A M Jansen1, Manouk Backes2, Dominique B Buck3
1Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, the Netherlands. sem.jansen@radboudumc.nl.
Purpose:
Pediatric trauma centers (PTCs) have been associated with lower mortality rates and increased use of non-operative management. While not formally designated, six trauma centers in the Netherlands meet PTC criteria and are referred to as designated pediatric trauma centers (dPTCs). This study aimed to evaluate the impact of treatment at dPTCs versus adult trauma centers (ATCs) on outcomes in severely injured pediatric patients in the Netherlands.
Methods:
Data were obtained from the Dutch National Trauma Registry for patients aged ≤ 16 years with an Injury Severity Score (ISS) ≥ 16, admitted between January 1, 2015, and December 31, 2022. Multivariable logistic regression was performed to assess the impact of treatment at a dPTC on in-hospital mortality and Glasgow Outcome Scale (GOS) scores.
Results:
In total, 2,378 patients were included: 63% were treated in dPTCs, 17% in ATC-I, and 20% in ATC-II/III. Mortality rates were 13.1% in dPTCs, 12.6% in ATC-I, and 2.1% in ATC-II/III (p < 0.001). For children under 12 years of age, treatment at a dPTC was independently associated with a lower risk of in-hospital mortality compared to ATC-I (odds ratio [OR] 1.99, p = 0.017). dPTC treatment was also associated with more favorable GOS outcomes compared to ATC-I (OR 0.68, p = 0.022) and ATC-II/III (OR 0.34, p < 0.001).
Conclusion:
Treatment at dPTCs is associated with a reduced risk of mortality for patients under 12 years of age and improved functional neurological outcomes. These findings support the further centralization of pediatric trauma care in the Netherlands.
