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

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 System Evaluation before and after Level II Verification

The American Surgeon ◽

10.1177/000313481908501137 ◽

2019 ◽

Vol 85 (11) ◽

pp. 1281-1287

Author(s):

Michael D. Dixon ◽

Scott Engum

Keyword(s):

Native American ◽

Trauma Center ◽

Injury Severity ◽

Life Support ◽

Pediatric Trauma ◽

Trauma System ◽

Trauma Centers ◽

Level Ii ◽

Level I ◽

Pediatric Trauma Center

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study ( P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group ( P = 0.0002); motorized recreational vehicle ( P = 0.028), violent ( P = 0.009), and other ( P = 0.0374) mechanism of injury categories; ambulance ( P = 0.0124), fixed wing ( P = 0.0028), and personal-owned vehicle ( P = 0.0112) modes of transportation. Decreased public injuries ( P = 0.0071) and advanced life support ambulance transportation ( P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.

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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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An analysis of pediatric trauma center undertriage in a mature trauma system

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002265 ◽

2019 ◽

Vol 87 (4) ◽

pp. 800-807 ◽

Cited By ~ 3

Author(s):

Amelia T. Rogers ◽

Michael A. Horst ◽

Tawnya M. Vernon ◽

Barbara A. Gaines ◽

Eric H. Bradburn ◽

...

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Trauma System ◽

Pediatric Trauma Center

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Toward a Comprehensive Emergency Medical System for Children

PEDIATRICS ◽

10.1542/peds.86.1.120 ◽

1990 ◽

Vol 86 (1) ◽

pp. 120-122

Author(s):

J. Alex Haller

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Pediatric Trauma ◽

Trauma System ◽

Objective Evaluation ◽

The United States ◽

The State ◽

Levels Of Care ◽

Emergency Medical ◽

Pediatric Trauma Center

Systems management of life-threatening injuries in children and adults is now accepted as state-of-the-art by those who care for trauma victims in the United States and Canada. A few regional trauma systems for adults have had several decades of experience and have recently served as models for inclusion of pediatric trauma.1 In certain instances, notably the state of Pennsylvania, an emergency medical services (EMS) system has come into being with fully integrated adult and children's components. That the National Pediatric Trauma Registry includes more than 12 000 children is indicative of the significant problem of trauma in childhood; the Registry has provided a necessary base for statistical analysis of injury severity and long-term rehabilitation needs.2 Since 1985, several federally funded state demonstration grants for EMS for children (EMSC) have attempted to establish guidelines for patient care and to suggest methods of ongoing monitoring of the effectiveness of these systems, surveillance of quality, and review of patient outcome. A statewide designated pediatric trauma center for Maryland located in The Johns Hopkins Children's Center has been functional for 12 years.3 Data are now available for objective evaluation of the effectiveness and impact of this regional pediatric trauma program. The level of compliance within Maryland's regionalized pediatric trauma system from 1979 through 1986 was recently examined using hospital discharge abstract data routinely recorded for all discharges from 58 acute care hospitals in the state of Maryland.4 Compliance with regionalization was measured by examining (1) the proportion of patients with injuries of varying injury severity scores5,6 who were treated at each of three levels of care (statewide pediatric trauma center, regional trauma center, and community hospital) and (2) the proportion of in-hospital deaths occurring at each level of care.

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Analysis of Head Injury Admission Trends in an Urban American Pediatric Trauma Center

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000197439.19171.25 ◽

2005 ◽

Vol 59 (6) ◽

pp. 1292-1297 ◽

Cited By ~ 11

Author(s):

Todd A. Ponsky ◽

Martin R. Eichelberger ◽

Eden Cardozo ◽

Zhihuan J. Huang ◽

Geraldine L. Pratsch ◽

...

Keyword(s):

Head Injury ◽

Trauma Center ◽

Pediatric Trauma ◽

Pediatric Trauma Center

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The pediatric trauma center and the inclusive trauma system

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000000610 ◽

2015 ◽

Vol 78 (5) ◽

pp. 930-934 ◽

Cited By ~ 16

Author(s):

Emily E.K. Murphy ◽

Stephen G. Murphy ◽

Mark D. Cipolle ◽

Glen H. Tinkoff

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Trauma System ◽

Pediatric Trauma Center

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To Scan or Not to Scan: Overutilization of Computed Tomography for Minor Head Injury at a Pediatric Trauma Center

Journal of Surgical Research ◽

10.1016/j.jss.2018.06.005 ◽

2018 ◽

Vol 232 ◽

pp. 164-170 ◽

Cited By ~ 1

Author(s):

Jeremy D. Kauffman ◽

Cristen N. Litz ◽

Sasha A. Thiel ◽

Anh Thy H. Nguyen ◽

Aaron Carey ◽

...

Keyword(s):

Computed Tomography ◽

Head Injury ◽

Trauma Center ◽

Pediatric Trauma ◽

Minor Head Injury ◽

Pediatric Trauma Center

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Paramedic and Surgeon Views on Trauma Surgical Readiness: Implications for Guideline Implementation

The American Surgeon ◽

10.1177/000313481808400669 ◽

2018 ◽

Vol 84 (6) ◽

pp. 1079-1085

Author(s):

Jerome Manson ◽

Kristen Burke ◽

Catherine P. Starnes ◽

Kristin Long ◽

Paul A. Kearney ◽

...

Keyword(s):

Disease Control ◽

Trauma Center ◽

Guideline Implementation ◽

Trauma System ◽

Trauma Centers ◽

System A ◽

Field Triage ◽

Cdc Guidelines ◽

General Surgeons ◽

Mere Presence

Centers for disease control (CDC) Guidelines for Field Triage are effective when proper implementation by EMS personnel is paired with surgeon willingness to care for trauma victims. We hypothesized that in a state with an immature trauma system, a discrepancy exists between medic and surgeon perception of surgical readiness, coinciding with inconsistent implementation of protocols. Surveys were conducted among medics and general surgeons. Destination protocols, trauma center locations, surgeon readiness, and interest in trauma were assessed. A standard clinical trauma scenario was also used. Surgeon willingness to operate is not affected by working outside of trauma centers or interest in trauma. Medics working far from trauma centers are less confident in local surgeon's willingness to operate and less likely to have destination protocols. Trauma center proximity affects medic perception of surgeon willingness to operate, but mere presence of general surgeons does not. In a trauma scenario, surgeon willingness to operate was related to medic perception but not action. In rural states, most surgeons do not work in trauma centers and most medics do not work near them. Although most responding surgeons indicate willingness to operate, medics are confident of such willingness only half the time. This disparity results in inconsistent use of the CDC guidelines. Although most medics report protocols for destination determination, nearly one-fourth of victims are taken to the geographically closest centers, sometimes with no surgeon at all. Efforts at medic training, enhancing surgeon readiness, and alignment of goals are necessary for the CDC Guidelines to be effective.

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Factors Associated with Time to Arrival at a Regional Pediatric Trauma Center

Prehospital and Disaster Medicine ◽

10.1017/s1049023x15005191 ◽

2015 ◽

Vol 31 (1) ◽

pp. 4-9 ◽

Cited By ~ 6

Author(s):

Folafoluwa O. Odetola ◽

N. Clay Mann ◽

Kristine W. Hansen ◽

Susan L. Bratton

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Prehospital Care ◽

Pediatric Trauma ◽

Factors Associated ◽

Private Vehicle ◽

Field Triage ◽

Severity Scores ◽

Prehospital Time ◽

Pediatric Trauma Center

AbstractObjectiveThe goal of this study was to test the hypothesis that the prehospital time between injury and arrival at a trauma center for critically injured children is associated with patient injury severity and mode of transport.MethodsSecondary analysis of prospectively collected data on children 0-17 years of age admitted with traumatic injuries to a designated Level I pediatric trauma center from January 1, 2006 through September 30, 2007 was conducted. Multivariate regression methods were used to assess for factors independently associated with prehospital time.ResultsOf 1,175 admissions during the study period, only 355 (30%) had a prehospital time within 60 minutes of injury. Prehospital time within 60 minutes of injury was associated with higher frequency of coma, higher mean injury severity scores (ISS), and greater frequency of admission to the intensive care unit when compared with prehospital time beyond 60 minutes of injury. Children who arrived at the trauma center within 60 minutes versus beyond 60 minutes were 13-fold (odds ratio [OR]: 12.9; 95% Confidence Interval [CI], 7.6-22.0) more likely to be transported via air ambulance than a private vehicle, and had 4.8-fold greater odds (95% CI, 2.2-10.3) of transport via ground ambulance than private vehicle. For each kilometer of distance between the injury zip code and the trauma center, the odds of arrival within 60 minutes versus beyond 60 minutes decreased by 15% (OR: 0.85; 95% CI, 0.79-0.91).ConclusionField triage and decision making appeared to correlate with severity of patient injury with expeditious transport of the most severely injured children to definitive trauma care. This finding serves as important groundwork that might enable further study into factors that influence triage and overall prehospital care for critically injured children.OdetolaFO, MannNC, HansenKW, BrattonSL. Factors associated with time to arrival at a regional pediatric trauma center. Prehosp Disaster Med. 2016;31(1):4–9.

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