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Efficacy of pediatric trauma care: results of a population-based study
A Cooper1, B Barlow, C DiScala
1Division of Pediatric Surgery, Harlem Hospital Center, College of Physicians & Surgeons of Columbia University, New York, NY 10037.
Insights
Pediatric trauma registries show surprising concordance in injury incidence and mortality, despite differences in trauma system organization. Pediatric trauma centers improve survival rates for severe brain, internal, and skeletal injuries.
Area of Science:
- Pediatric Trauma Care
- Public Health Surveillance
- Injury Epidemiology
Background:
- A state lacking a well-organized trauma system was assessed for pediatric injury outcomes.
- Comparison was made between regional data and national trauma center data.
Purpose of the Study:
- To determine concordance between regional and national pediatric trauma outcome data.
- To assess injury diagnosis, severity, and mortality in a state with a developing trauma system.
Main Methods:
- Compared pediatric trauma discharge abstracts from the Statewide Planning and Research Cooperative System (SPARCS) with National Pediatric Trauma Registry (NPTR) data.
- Analyzed 14,234 SPARCS cases and 17,098 NPTR cases from the late 1980s.
- Grouped data by principal anatomic diagnosis (ICD-9-CM N-code) and Injury Severity Score (ISS), calculating incidence and mortality.
Main Results:
- Overall discordance was observed, with NPTR data skewed toward more severe injuries.
- Striking cell-by-cell concordance in incidence and mortality for comparable injury severities emerged.
- Pediatric trauma centers treated isolated skeletal injuries less frequently but combined system injuries more frequently.
- Survival was significantly higher (approx. 10x) in pediatric trauma centers for severe brain, internal, and skeletal injuries compared to SPARCS data.
Conclusions:
- Despite differences in trauma system organization, significant concordance exists in pediatric injury incidence and mortality data.
- Pediatric trauma centers demonstrate improved survival outcomes for severe pediatric injuries, particularly brain, internal, and skeletal trauma.
- Findings highlight the benefit of specialized pediatric trauma care in reducing mortality for critical injuries.
Abstract:
To determine concordance between regional outcome and national norms with respect to pediatric injury diagnosis, severity, and mortality in a state lacking a well-organized trauma system, we compared summary data from all pediatric trauma-related hospital discharge abstracts compiled by the [New York State Department of Health] Statewide Planning and Research Cooperative [Mandatory Hospital Reporting] System (SPARCS), with comparable data from pediatric trauma centers participating in the National Pediatric Trauma Registry (NPTR), for similar epochs in the late 1980s. Analysis was based on 14,234 cases from SPARCS and 17,098 cases from NPTR. Data were grouped by principal anatomic diagnosis (ICD-9-CM N-code) and injury severity score (ISS), for each of which incidence and mortality were calculated, both individually and collectively, then compared item by item for sources of variance. Overall, the two data sets showed the expected discordance, with NPTR being skewed toward more complex and severe injury. However, when analyzed cell by cell, a striking degree of concordance emerged in both incidence and mortality for injuries of comparable severity in all but a few selected subsets. Isolated skeletal injuries were treated less frequently in pediatric trauma centers, and combined system injuries to the skeleton, brain, and internal organs were treated more frequently in pediatric trauma centers. However, while the fatality rates were similar between SPARCS and NPTR for most diagnoses, given comparable ISS, survival was some ten times greater in pediatric trauma centers for patients with either brain or internal injuries--the leading causes of pediatric injury mortality--and for skeletal injuries, when the injuries sustained were of moderately great severity.(ABSTRACT TRUNCATED AT 250 WORDS)