A Statewide Analysis of Pediatric Liver Injuries Treated at Adult Versus Pediatric Trauma Centers

Pediatric liver and spleen injuries are frequently treated in specialized hospitals. Not all injured children, however, are treated in referral centers. We evaluated the management of pediatric liver and spleen injuries in a rural state without a state trauma system to determine if differences existed between trauma centers and nontrauma centers. A state database was queried for patients ≤15-years-old who suffered liver and spleen injuries from 2003 to 2005. Iatrogenic injuries were excluded. There were 115 pediatric liver and 183 pediatric spleen injuries. Fifty per cent of liver and 63 per cent of spleen injuries in nontrauma centers were isolated solid organ injuries compared with 18 per cent and 36 per cent, respectively, in trauma centers. The mortality rate for both liver and spleen injuries was similar in trauma and nontrauma centers. Hospital charges were higher in trauma centers but this was due to patients with associated injuries. The nonoperative management rate was similar for liver injuries. Pediatric patients with splenic injuries had a lower rate of nonoperative management in nontrauma centers (75% to 90%, nontrauma vs trauma). In Kentucky, pediatric solid organ injuries are usually managed nonoperatively in both trauma and nontrauma centers, but trauma centers cared for fewer isolated solid organ injuries.

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Management of pediatric liver injuries: A 13-year experience at a pediatric trauma center

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(99)90378-0 ◽

1999 ◽

Vol 34 (5) ◽

pp. 811-817 ◽

Cited By ~ 29

Author(s):

Matthew Gross ◽

Frank Lynch ◽

Timothy Canty ◽

Bradley Peterson ◽

Robert Spear

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Pediatric Liver ◽

Liver Injuries ◽

Pediatric Trauma Center

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Injured Children Fare Best at Pediatric Trauma Centers

Pediatric News ◽

10.1016/s0031-398x(05)70732-3 ◽

2005 ◽

Vol 39 (11) ◽

pp. 39

Author(s):

JANE SALODOF MACNEIL

Keyword(s):

Pediatric Trauma ◽

Trauma Centers

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Outcome in an Urban Pediatric Trauma System with Unified Prehospital Emergency Medical Services Care

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00041601 ◽

1995 ◽

Vol 10 (1) ◽

pp. 19-23 ◽

Cited By ~ 11

Author(s):

Michael J. VanRooyen ◽

Edward P. Sloan ◽

John A. Barrett ◽

Robert F. Smith ◽

Hernan M. Reyes

Keyword(s):

Head Injury ◽

Mortality Rate ◽

Trauma Center ◽

Pediatric Trauma ◽

Trauma System ◽

Age Groups ◽

Mortality Rates ◽

Trauma Centers ◽

Field Triage ◽

Pediatric Trauma Center

AbstractHypothesis:Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.Population:Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.Methods:Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.Results:Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.Conclusions:Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.

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Pediatric trauma centers

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e318265ca6f ◽

2012 ◽

Vol 73 (3) ◽

pp. 566-572 ◽

Cited By ~ 27

Author(s):

David M. Notrica ◽

Jeffrey Weiss ◽

Pamela Garcia-Filion ◽

Erin Kuroiwa ◽

Daxa Clarke ◽

...

Keyword(s):

Pediatric Trauma ◽

Trauma Centers

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Re: Injured Children Receive Twice the Radiation Dose at Nonpediatric Trauma Centers Compared With Pediatric Trauma Centers

Journal of the American College of Radiology ◽

10.1016/j.jacr.2017.10.036 ◽

2018 ◽

Vol 15 (6) ◽

pp. 825

Author(s):

M. Crockett Bone ◽

Michael J. Schlosser ◽

Jonathan B. Perlin

Keyword(s):

Radiation Dose ◽

Pediatric Trauma ◽

Trauma Centers

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Genitourinary Injuries Secondary to Break Dancing in Children and Adolescents

PEDIATRICS ◽

10.1542/peds.77.6.922 ◽

1986 ◽

Vol 77 (6) ◽

pp. 922-924

Author(s):

JOHN P. GEARHART ◽

FRANKLIN C. LOWE

Keyword(s):

Children And Adolescents ◽

Blunt Trauma ◽

Cause Of Death ◽

Motor Vehicle ◽

Pediatric Trauma ◽

Motor Vehicle Accidents ◽

Genitourinary Tract ◽

Trauma Centers ◽

Rare Occurrence ◽

Vehicle Accidents

Trauma to the lower genitourinary tract in children and adolescents has been a rare occurrence. However, with the advent of pediatric trauma centers, more of these injuries are now being seen and evaluated. Although trauma to the genitourinary tract alone is an uncommon cause of death, trauma centers are seeing more children in which decisions regarding the management of the genitourinary tract must be made. Most injuries that have been reported have been secondary to blunt trauma such as straddle injuries, falls, or motor vehicle accidents. Recently, two cases of lower genitourinary tract trauma have been seen associated with the current fad of break dancing.

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Pediatric Trauma Deaths: A Three-Part Analysis from a Nonacademic Trauma Center

The American Surgeon ◽

10.1177/000313480607200311 ◽

2006 ◽

Vol 72 (3) ◽

pp. 249-259

Author(s):

Mary O. Aaland ◽

Thein Hlaing

Keyword(s):

Mortality Rate ◽

Trauma Center ◽

Pediatric Trauma ◽

Trauma System ◽

Time Frame ◽

Level Ii ◽

Liver Injuries ◽

Depth Analysis ◽

Trauma Mortality ◽

Trauma Deaths

A three-part analysis was undertaken to assess pediatric trauma mortality in a nonacademic Level II trauma center at Parkview Hospital in Fort Wayne, Indiana. Part I was a comparison of Parkview trauma registry data collected from 1999 through 2003 with those of pediatric and adult trauma centers in Pennsylvania. The same methodology used in Pennsylvania was used for the initial evaluation of pediatric deaths from trauma in our trauma center. Part II was a formal in-depth analysis of all individual pediatric deaths as well as surgical cases with head, spleen, and liver injuries from the same time frame. Part III proposes a new methodology to calculate a risk-adjusted mortality rate based on the TRISS model for the evaluation of a trauma system. The use of specific mortality and surgical intervention rates was not an accurate reflection of trauma center outcome. The proposed risk-adjusted mortality rate calculation is perhaps an effective outcome measure to assess patient care in a trauma system.

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