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Comparing complications in pediatric trauma patients transported before and after 30 minutes
George Hung1, Theodore Wang1, Eileen Hsieh1
1Division of Pediatric Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08820, United States.
Insights
Longer prehospital transport times for pediatric trauma patients (≥30 minutes) are linked to increased mortality and hospital complications. Early intervention is crucial for improving outcomes in pediatric trauma care.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Public Health
Background:
- The
Purpose of the Study:
- To evaluate the association between prehospital transport time and outcomes in pediatric trauma patients.
- To determine if a transport time threshold exists that significantly impacts mortality and morbidity.
Main Methods:
- Retrospective analysis of the National Trauma Data Bank (NTDB) cohort.
- Inclusion of pediatric patients (ages 4-16) with severe injuries transported within 1 hour.
- Dichotomization of transport times into <30 minutes and ≥30 minutes for comparative analysis.
Main Results:
- Patients with transport times ≥30 minutes showed increased mortality (4.7%) compared to those <30 minutes (8.8%).
- Longer transport times (≥30 min) were associated with a higher likelihood of renal complications (OR 4.0).
- Specific thresholds for increased complications were identified: ≥25 min for aggregated hospital complications, ≥20 min for clots and respiratory issues, and ≥15 min for mortality and infection.
Conclusions:
- Prehospital transport times of ≥30 minutes are associated with increased mortality and morbidity in pediatric trauma patients.
- The findings underscore the importance of rapid transport and early intervention to mitigate adverse outcomes.
- Further research into early outcome prediction models is recommended to guide timely interventions.
Introduction:
The "golden hour" principle emphasizes rapid patient transport and intervention to improve adult trauma outcomes, but its relevance to pediatric patients is uncertain. This study examined whether a <30 min prehospital transport time was associated with improved outcomes compared to the previous 60 min threshold for mortality and morbidity.
Method:
The National Trauma Data Bank (NTDB) was queried for pediatric patients (ages 4-16) transported under 1 h and dichotomized by EMS transport time (<30 or ≥30 min). Exclusions included non-severe injury severity score (ISS ≤15), fatal injuries, deaths on arrival, and non-blunt mechanisms of injury. Baseline characteristics, including age, sex, ISS, Glasgow coma score (GCS), shock index (SI), and pediatric-adjusted shock index (SIPA), were compared between groups. Multivariable regression determined the likelihood of the primary outcome, mortality, with secondary outcomes including hospital complications.
Results:
Of 3325 pediatric patients, 920 (27.7 %) were transported <30 min and 2405 (72.3 %) ≥30 min. In the ≥30 min' group, 64.3 % (p = 0.27) were male, 62.8 % (p = 0.24) adolescents (age 12-16), 7.4 % (p = 0.01) severe SI (>1.4), 30.0 % (p = 0.14) elevated SIPA, and 19.1 % (p < 0.001) severe GCS (3-8). Mortality was 8.8 % for <30 and 4.7 % for ≥30 min (p < 0.001). A transport ≥30 min was strongly associated with increased likelihood of renal complications (OR 4.0, CI 1.1-19.6). Further, changing transport time by 5 min intervals revealed the thresholds at which mortality and complications, both aggregated and disaggregated increase drastically: aggregated hospital complications (OR 1.7, CI 1.0-3.0), operating room procedures (OR 2.7, CI 1.1-6.8), unplanned ICU admissions (OR 2.9, CI 1.1-8.8), intubation (OR 4.0, CI 1.5-12.5), and pressure ulcer (OR 3.0, CI 1.2-8.5) at the ≥25 min threshold; clots (OR 8.9, CI 2.4-58.0), respiratory (OR 10.3, CI 1.9-191.5), cardiac arrest (OR 3.0, CI 1.2-8.1), pneumonia (OR 7.0, CI 1.7-47.9), and DVT (OR 10.6, CI 1.9-199.5) at the ≥20 min threshold; and mortality (OR 2.7, CI 1.1-7.7) and infection (OR 5.4, CI 1.7-24.3) at the ≥15 min threshold.
Conclusion:
Pediatric trauma patients with ≥30 min prehospital transport time have an increased likelihood of subsequent hospital mortality and morbidity, highlighting the need for early outcome prediction to guide timely interventions and reduce preventable mortality and morbidity.
Study Type:
Retrospective large database cohort analysis.
Level Of Evidence:
III.
