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

2015 ◽  
Vol 31 (1) ◽  
pp. 4-9 ◽  
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.

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

1995 ◽  
Vol 10 (1) ◽  
pp. 19-23 ◽  
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.

Factors Associated with Patients Transfered to a Level 1 Pediatric Trauma Center with Orthopaedic Injuries

2018 ◽  
Author(s):  
Selina Poon ◽  
Jonathan Berkowitz ◽  
Jeffrey Goldstein ◽  
Ishu Kant ◽  
Michael Marchese ◽  
...  
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Factors Associated ◽  
Level 1 ◽  
Orthopaedic Injuries ◽  
Pediatric Trauma Center

Toward a Comprehensive Emergency Medical System for Children

PEDIATRICS ◽  
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.

Three-Wheel and Four-Wheel All-Terrain Vehicle Injuries in Children

PEDIATRICS ◽  
1989 ◽  
Vol 84 (4) ◽  
pp. 694-698
Author(s):  
Margaret A. Dolan ◽  
Jane F. Knapp ◽  
Jody Andres
Keyword(s):  
Motor Skills ◽  
Trauma Center ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Common Factors ◽  
The United States ◽  
High Incidence ◽  
Level I ◽  
Serious Injuries ◽  
Pediatric Trauma Center

In January 1988, sales of new three-wheel all-terrain vehicles (ATVs) were banned in the United States because of the high incidence of injury associated with their use, especially by children. Four-wheel ATVs remain on the market. A retrospective review of all ATV injuries seen in a level I pediatric trauma center was conducted to compare the nature and severity of injuries in three-wheel vehicles with those associated with four-wheelers. A total of 36 ATV injuries were seen from April 1986 to August 1988. All patients were < 16 years of age; 72% were ≤12 years of age. Of the patients, 56% were boys; 44% were girls. Although 56% of incidents involved three-wheelers, a larger number of more serious injuries, defined as the presence of indicators of injury severity (eg, death, Injury Severity Score ≥10, intensive care unit admission, or need for surgery), involved four-wheel vehicles. A total of 15 injuries occurred in 1987; 12 injuries, including the first death involving an ATV at the pediatric trauma center, occurred in the 7 months since the sales ban. Immature judgment and/or motor skills were the most common factors contributing to injury. Existing information regarding injuries involving three-wheel ATVs is supported by our data, according to which it is suggested that four-wheel vehicles may be dangerous in the hands of immature or unskilled operators < 16 years of age. Injury prevention efforts should be directed at prohibiting any ATV use by persons < 16 years of age.

Pediatric Trauma System Evaluation before and after Level II Verification

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.

Atraumatic Transition from a Pediatric Emergency Center to a Pediatric Trauma Center: A Fight for Better Outcomes

2018 ◽  
Vol 84 (9) ◽  
pp. 1489-1492
Author(s):  
Marina Gorelik ◽  
Adel Elkbuli ◽  
Shaikh Hai ◽  
Ascension Torres ◽  
Mark McKenney
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Trauma Center ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Pediatric Emergency ◽  
Emergency Center ◽  
Surgical Interventions ◽  
One Year ◽  
Pediatric Trauma Center

Opening a new pediatric trauma center (PTC) is a sizable undertaking. A pediatric trauma team of specialists must be assembled, appropriate equipment and facilities prepared, and staff educated. Our PTC opened in May 2016, before that we had a pediatric emergency center. This study aimed to evaluate initial performance, and compare practices and outcomes before and after becoming a PTC. A review of prospectively collected data using our hospital's Trauma Registry. We compared patient profiles and outcomes 4.5 years before and one year after our hospital became a PTC. Demographic variables, outcomes, Injury Severity Score, and surgical interventions were compared. Chi Squared analysis and t test were used, with significance defined as P < 0.05. For the 4.5 years before opening the PTC, we averaged 96 pediatric trauma admissions annually. After opening, we had 289 admissions in one year, (146% increase, P < 0.05). Mean Injury Severity Score significantly increased from 3.7 to 5.3 postopening (P < 0.05), as did the number of surgical interventions from 19 to 88 (P < 0.001), but mortality did not change (no deaths). Transfers out of the hospital significantly decreased (3.8%) compared with preopening (10.4%, P = 0.03), whereas transfers into the hospital significantly increased, (38 compared with 62, P = 0.003). When mode of transportation was compared, pre- and postopening of the PTC, patient transport by air increased from 3 per cent to 35 per cent (P < 0.001). Transitioning from a pediatric emergency center to a PTC resulted in increased patient volumes, presentation of more severely injured patients, and increased surgical interventions, without a change in mortality.

An Analysis of Pediatric Gunshot Wounds Treated at a Level I Pediatric Trauma Center

2003 ◽  
Vol 54 (6) ◽  
pp. 1102-1106 ◽  
Author(s):  
Alison K. Snyder ◽  
Li Ern Chen ◽  
Robert P. Foglia ◽  
Patrick A. Dillon ◽  
Robert K. Minkes
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Gunshot Wounds ◽  
Level I ◽  
Pediatric Trauma Center
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