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Pediatric Penetrating Trauma Volume and Patient Outcome: A National Trauma Data Bank Study
Ayaka Tsutsumi1, Ruizhi Huang2, Paula Buchanan2
1Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, Saint Louis, Missouri.
Insights
Higher trauma center volume for pediatric penetrating injuries did not impact mortality but increased resource use. This suggests volume may affect care intensity, not survival rates, in pediatric trauma patients.
Area of Science:
- Pediatric Trauma Surgery
- Injury Epidemiology
- Health Services Research
Background:
- Firearm-related injuries are the leading cause of death in US children.
- The relationship between trauma center volume and outcomes in pediatric penetrating trauma is not well-understood.
- This study investigates the volume-outcome relationship in pediatric penetrating injuries.
Purpose of the Study:
- To evaluate the association between trauma center volume and patient outcomes.
- To analyze the impact of high-volume centers on pediatric penetrating trauma care.
- To determine if increased volume correlates with improved survival or resource utilization.
Main Methods:
- Retrospective analysis of the National Trauma Data Bank (2017-2021).
- Included pediatric patients (1-18 years) with stab wounds or gunshot wounds (GSWs).
- Trauma centers stratified into quartiles by penetrating injury volume; outcomes included mortality, ICU stay, and ventilator duration.
Main Results:
- In-hospital mortality (4%-5%) showed no significant difference across volume quartiles.
- Highest-volume centers (q4) had longer intensive care unit stays and ventilator durations.
- Prolonged ventilator dependency was significant in q4 facilities, even after matching (RR=1.256, P=0.008).
Conclusions:
- Trauma center volume influences resource utilization in pediatric penetrating trauma.
- Volume does not significantly affect in-hospital mortality for pediatric penetrating injuries.
- Further research with precise injury matching is needed to clarify these relationships.
Introduction:
Firearm-related injuries have become the leading cause of death for US children. Although a "volume-outcome" relationship is well-established in adults, it is less understood in pediatric penetrating trauma. This study aimed to evaluate the relationship between trauma center volume and patient outcomes in pediatric penetrating injuries.
Methods:
Utilizing the National Trauma Data Bank (2017-2021), we conducted a retrospective database study of pediatric patients (1-18 y) with stab or gunshot wounds (GSWs), treated at level I or II trauma centers. Patients with GSW to the head, interfacility transfers, or emergency department deaths were excluded. Trauma centers were categorized into quartiles based on penetrating injury volume. Primary outcomes were in-hospital mortality, intensive care unit length of stay, and ventilator dependency duration.
Results:
Of 666,111 patients, 34,064 with penetrating trauma were included, with 22,237 sustaining GSW. In-hospital mortality (4%-5%) did not significantly differ across volume quartiles. Patients at the highest-volume facilities (q4) experienced longer intensive care unit stays (4.33 d in q1 versus 5.45 d in q4, P < 0.001) and longer ventilator duration (3.22 d in q1 versus 4.90 d in q4, P < 0.001). After 3:1 matching to minimize confounding, prolonged ventilator dependency remained statistically significant in q4 facilities (relative risk = 1.256, P = 0.008), a trend also seen in the GSW subgroup (relative risk = 1.264, P = 0.016).
Conclusions:
This study indicates that while trauma center volume may influence resource utilization for pediatric penetrating trauma, it does not significantly affect in-hospital mortality. Further research with more anatomically precise injury matching is warranted.
