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A national analysis of pediatric trauma care utilization and outcomes in the United States
  • Published Date:
    Sep 09 2016
  • Source:
    Pediatr Emerg Care. .


Public Access Version Available on: March 09, 2018 information icon
Please check back on the date listed above.
Details:
  • Pubmed ID:
    27618592
  • Pubmed Central ID:
    PMC5344780
  • Funding:
    R01 CE001615/CE/NCIPC CDC HHS/United States
    K08 HS017960/HS/AHRQ HHS/United States
    KM1 CA156715/CA/NCI NIH HHS/United States
    F32 HS018604/HS/AHRQ HHS/United States
    R49 CE002474/CE/NCIPC CDC HHS/United States
    R03 HD061523/HD/NICHD NIH HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Objectives

    More childhood deaths are attributed to trauma than all other causes combined. Our objectives are to provide the first national description of the proportion of injured children treated at pediatric trauma centers (TC), and to provide clarity to the presumed benefit of pediatric TC verification by comparing injury mortality across hospital types.

    Methods

    We performed a population-based cohort study using the 2006 HCUP Kids Inpatient Database combined with national TC inventories. We included pediatric discharges (≤16yrs) with ICD-9 code(s) for injury. Descriptive analyses were performed evaluating proportions of injured children cared for by TC level. Multivariable logistic regression models were used to estimate differences in in-hospital mortality by TC type (among level-1 TCs only). Analyses were survey-weighted using HCUP sampling weights.

    Results

    Of 153,380 injured children, 22.3% were admitted to pediatric TCs, 45.2% to general TCs and 32.6% to non-TCs. Overall mortality was 0.9%. Among level-1 TCs, raw mortality was 1.0% ped TC, 1.4% dual TC, and 2.1% general TC. In adjusted analyses, treatment at level-1 pediatric TCs was associated with a significant mortality decrease compared to level-1 general TCs (Adjusted OR 0.6, 95%CI 0.4-0.9).

    Conclusions

    Our results provide the first national evidence that treatment at verified pediatric TCs may improve outcomes, supporting a survival benefit with pediatric trauma verification. Given lack of similar survival advantage found for level-1 dual TCs (both general/pediatric verified), we highlight need for further investigation to understand factors responsible for the survival advantage at pediatric-only TCs, refine pediatric accreditation guidelines and disseminate best practices.

  • Supporting Files:
    No Additional Files