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Influence of a statewide trauma system on pediatric hospitalization and outcome
F Hulka1, R J Mullins, N C Mann
1Department of Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.
Insights
Oregon's statewide trauma system reduced the risk of death for seriously injured children compared to Washington. Both states saw fewer child injury hospitalizations and deaths, likely due to injury prevention efforts.
Area of Science:
- Pediatric trauma care
- Public health policy
- Injury epidemiology
Background:
- A statewide trauma system was implemented in Oregon between 1987-1991, while Washington did not implement a similar system.
- This study compares pediatric injury hospitalization and mortality rates in Oregon and Washington before and after the trauma system implementation.
Purpose of the Study:
- To compare the incidence of hospitalization, frequency of death, and risk-adjusted odds of death for injured children in Oregon and Washington.
- To evaluate the impact of a statewide trauma system on pediatric injury outcomes.
Main Methods:
- Utilized the International Classification of Diseases, 9th Revision-Clinical Modification (ICD-9-CM) codes 800-959 from a Hospital Discharge Index to identify injured children.
- Defined rural hospitals as those in counties with a population density below 50 persons per square mile.
- Calculated incidence rates as events per 10,000 pediatric population per year.
Main Results:
- Pediatric hospitalization incidence declined in both states for all injured children and in rural hospitals.
- Seriously injured children (Injury Severity Score > 15) showed a lower incidence of admission to rural hospitals in 1991-1993 compared to the entire state incidence.
- Risk-adjusted odds of death for seriously injured children were significantly lower in Oregon than in Washington during the 1991-1993 period.
Conclusions:
- Both Oregon and Washington experienced a decline in pediatric injury deaths, suggesting the effectiveness of injury prevention strategies.
- Seriously injured children in Oregon had a reduced risk of death, supporting the benefit of a statewide trauma system.
Background:
During the years 1987-1991, a statewide trauma system was implemented in Oregon (Ore) but not in Washington (Wash). Incidence of hospitalization, frequency of death and risk-adjusted odds of death for injured children (< 19 years) in the two adjacent states were compared for two time periods (1985-1987 and 1991-1993).
Methods:
State populations of injured children (International Classification of Diseases, 9th Revision-Clinical Modification, code 800-959) were identified through a Hospital Discharge Index. Hospitals in counties with a population density < 50 persons/square mile were designated rural. Incidence rates are events/10,000 pediatric population per year.
Results:
The pediatric population increased in both states (Ore: 687,000-758,000; Wash: 1,159,000-1,336,000). Incidence of hospitalization for all injured children in entire states declined (Ore: 66.5-38.5; Wash: 54-33); also in rural hospitals (Ore: 67.5-32; Wash: 48 to 31). Seriously injured children (score on the Injury Severity Scale > 15) had a lower incidence in 1991-1993 of admission to rural hospitals (Ore: 2.98; Wash: 2.82) compared with incidence for entire states (Ore: 4.61; Wash: 4.62); in 1985-1987 the incidence was not different. Furthermore risk adjusted odds of death for seriously injured children was significantly lower in Oregon than in Washington in the later time period.
Conclusion:
Both states show a similar temporal trend toward a declining frequency of death for children hospitalized with injuries. Injury prevention strategies appear to have reduced the number of serious injuries in both states. However, seriously injured children demonstrated a reduced risk of death in Oregon, consistent with benefit from a statewide trauma system.