Should All Severely Injured Pediatric Patients be Treated at Pediatric Level I Trauma Centers? A National Trauma Data Bank Study

2015 ◽  
Vol 81 (10) ◽  
pp. 927-931
Author(s):  
Shin Miyata ◽  
Tobias Haltmeier ◽  
Kenji Inaba ◽  
Kazuhide Matsushima ◽  
Catherine Goodhue ◽  
...  
Keyword(s):  
Trauma Center ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Data Bank ◽  
Trauma Centers ◽  
National Trauma ◽  
Level Ii ◽  
National Trauma Data Bank ◽  
Level I

The American College of Surgeons Committee on Trauma stratification system for trauma centers presumes that increasing levels of resources will improve patient outcomes. Although some supportive data exist in adult trauma, there is a paucity of evidence demonstrating improved survival in pediatric trauma when patients are treated primarily at Level I versus Level II pediatric trauma centers. We hypothesized that there is no difference in the mortality of comparably injured pediatric patients treated at these two types of facilities. The study population consists of all severely injured pediatric patients (18 years old or younger, injury severity score > 15) registered in the National Trauma Data Bank, treated in designated pediatric trauma centers. A total of 13,803 patients were included in the analysis and were separated into two groups: Pediatric Level I trauma center (n = 9690) and Pediatric Level II trauma center (n = 4113). Although analysis of the clinical characteristics of the unmatched groups showed significant differences including mortality rate (11.7% vs 15.4%, P < 0.001), case matching technique, comparing 2956 pairs, successfully eliminated demographic differences and, when adjusted for injury severity, showed no difference in mortality between center types (10.0% vs 10.1%, P = 0.966, odds ratio of mortality = 0.996 and 95% confidence interval = 0.841–1.180). Subgroup analyses including Glasgow Coma Scale < 9, need for immediate procedures, and ICD-9 (International Classification of Diseases) code groupings indicative of serious injury also failed to demonstrate statistically significant differences in mortality between trauma center types.

Are All Level I Trauma Centers Created Equal? A Comparison of American College of Surgeons and State-Verified Centers

2011 ◽  
Vol 77 (10) ◽  
pp. 1334-1336 ◽  
Author(s):  
Jennifer Smith ◽  
David Plurad ◽  
Kenji Inaba ◽  
Peep Talving ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Injury Severity ◽  
Distress Syndrome ◽  
Data Bank ◽  
Trauma Centers ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
American College Of Surgeons ◽  
Outcome Differences ◽  
Level I ◽  
Facility Size

Scant literature investigates potential outcome differences between Level I trauma centers. We compared overall survival and survival after acute respiratory distress syndrome (ARDS) in patients admitted to American College of Surgeons (ACS)-verified versus state-verified Level I trauma centers. Using the National Trauma Data Bank Version 7.0, incident codes associated with admission to an ACS-verified facility were extracted and compared with the group admitted to state-verified centers. Overall, there were 382,801 (73.7%) patients admitted to ACS and 136,601 (26.3%) admitted to state centers. There was no adjusted survival advantage after admission to either type (4.9% for ACS vs 4.8% for state centers; 1.014 [95% CI, 0.987 to 1.042], P = 0.311). However, in the 3,088 cases of ARDS, mortality for admission to the ACS centers was 20.3 per cent (451 of 2,220) versus 27.1 per cent (235 of 868) for state centers. Adjusting for injury severity and facility size, admission to an ACS center was associated with a significantly greater survival after ARDS (0.75 [0.654 to 0.860]; P < 0.001). Level I verification does not necessarily imply similar outcomes in all subgroups. Federal oversight may become necessary to ensure uniformity of care, maximizing outcomes across all United States trauma systems. Further study is needed.

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.

Outcomes after Severe Head Injury: A National Trauma Data Bank-Based Comparison of Level I and Level II Trauma Centers

2011 ◽  
Vol 77 (3) ◽  
pp. 277-280 ◽  
Author(s):  
Fuad Alkhoury ◽  
John Courtney
Keyword(s):  
Head Injury ◽  
Complication Rate ◽  
Data Bank ◽  
Trauma Centers ◽  
National Trauma ◽  
Level Ii ◽  
Head Injured ◽  
National Trauma Data Bank ◽  
Level I ◽  
Injured Patients

Severely head-injured patients require significant resources across the continuum of care. The objective of this study is to analyze the impact of the level of trauma center designation on the outcome of the severely head-injured patient. The National Trauma Data Bank between 2001 and 2006 (NTDB 6.2) was queried for all patients with isolated traumatic head injury and Glasgow Coma Score (GCS) less than 9. Comparisons between Level I and Level II trauma centers were made reviewing hospital length of stay (LOS), intensive care unit LOS, ventilator days, major complication rate (pulmonary embolism, pneumonia, lower extremity deep vein thrombosis), mortality, and discharge status. Chi-square and Student t tests were used to determine statistical significance defined as P < 0.05. There were 31,736 patients from 258 facilities who met the inclusion criteria during the study period. Level I trauma centers had approximately twice as many patients admissions as Level II centers. However, the severity of injuries and patients’ characteristics identified by the emergency department GCS as well as the probability of survival score showed no difference between Level I and Level II centers. The comparisons between Level I and Level II trauma centers shows that Level II centers are not inferior to Level I in terms of outcomes and complication rate. Level II trauma centers encounter patients with isolated complex head injury less often but with outcomes and complication rates comparable to that of Level I centers. The transport of head-injured patients should not bypass Level II in favor of Level I.

Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers

2022 ◽  
pp. 000313482110335
Author(s):  
Aryan Haratian ◽  
Areg Grigorian ◽  
Karan Rajalingam ◽  
Matthew Dolich ◽  
Sebastian Schubl ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Trauma Center ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Improvement Program ◽  
Blunt Abdominal Injury ◽  
Level Ii ◽  
American College Of Surgeons ◽  
Level I

Introduction An American College of Surgeons (ACS) Level-I (L-I) pediatric trauma center demonstrated successful laparoscopy without conversion to laparotomy in ∼65% of trauma cases. Prior reports have demonstrated differences in outcomes based on ACS level of trauma center. We sought to compare laparoscopy use for blunt abdominal trauma at L-I compared to Level-II (L-II) centers. Methods The Pediatric Trauma Quality Improvement Program was queried (2014-2016) for patients ≤16 years old who underwent any abdominal surgery. Bivariate analyses comparing patients undergoing abdominal surgery at ACS L-I and L-II centers were performed. Results 970 patients underwent abdominal surgery with 14% using laparoscopy. Level-I centers had an increased rate of laparoscopy (15.6% vs 9.7%, P = .019 ); however they had a lower mean Injury Severity Score (16.2 vs 18.5, P = .002) compared to L-II centers. Level-I and L-II centers had similar length of stay ventilator days, and SSIs (all P > .05). Conclusion While use of laparoscopy for pediatric trauma remains low, there was increased use at L-I compared to L-II centers with no difference in LOS or SSIs. Future studies are needed to elucidate which pediatric trauma patients benefit from laparoscopic surgery.

The Impact of American College of Surgeons Trauma Center Designation and Outcomes after Early Thoracotomy: A National Trauma Databank Analysis

2012 ◽  
Vol 78 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Marko Bukur ◽  
Bernardino Castelo Branco ◽  
Kenji Inaba ◽  
Ramon Cestero ◽  
Leslie Kobayashi ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
National Trauma ◽  
Level Ii ◽  
Pressure Time ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Level I ◽  
The Impact

Trauma centers are designated by the American College of Surgeons (ACS) into four different levels based on resources, volume, and scientific and educational commitment. The purpose of this study was to evaluate the relationship between ACS center designation and outcomes after early thoracotomy for trauma. The National Trauma Databank (v. 7.0) was used to identify all patients who required early thoracotomy. Demographics, clinical data, and outcomes were extracted. Patients were categorized according to ACS trauma center designation. Multivariate logistic regression was used to evaluate the impact of ACS trauma center designation on mortality. From 2002 to 2006, 1834 (77.4%) patients were admitted to a Level I ACS verified trauma center, 474 (20.0%) to a Level II, and 59 (3.6%) to a Level III/IV facility. After adjusting for differences between the groups, there were no significant differences in mortality (overall: 53.3% for Level I, 63.1% for Level II, and 52.5% for Level III/IV, adjusted P = 0.417; or for patients arriving in cardiac arrest: 74.9% vs 87.1% vs 85.0%, P = 0.261). Subgroup analysis did not show any significant difference in survival irrespective of mechanism of injury. Glasgow Coma Scale score # 8, Injury Severity Score >16, no admission systolic blood pressure, time from admission to thoracotomy, and nonteaching hospitals were found to be independent predictors of death. For trauma patients who have sustained injuries requiring early thoracotomy, ACS trauma center designation did not significantly impact mortality. Nonteaching institutions however, were independently associated with poorer outcomes after early thoracotomy. These findings may have important implications in educational commitment of institutions. Further prospective evaluation of these findings is warranted.

Utilization of computed tomography in pediatric trauma: a comparison of trauma centers using the National Trauma Data Bank

2014 ◽  
Vol 219 (4) ◽  
pp. e130
Author(s):  
Kristy Rialon ◽  
Brian R. Englum ◽  
Brian C. Gulack ◽  
Syamal D. Bhattacharya ◽  
Lindsay Talbot ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pediatric Trauma ◽  
Data Bank ◽  
Trauma Centers ◽  
National Trauma ◽  
National Trauma Data Bank

Decreased Intracranial Pressure Monitor Use at Level II Trauma Centers is Associated with Increased Mortality

2012 ◽  
Vol 78 (10) ◽  
pp. 1166-1171 ◽  
Author(s):  
Galinos Barmparas ◽  
Matthew Singer ◽  
Eric Ley ◽  
Rex Chung ◽  
Darren Malinoski ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Trauma Center ◽  
Injury Severity ◽  
Regression Modeling ◽  
Trauma Centers ◽  
Icp Monitoring ◽  
Pressure Monitor ◽  
Brain Trauma Foundation ◽  
Level Ii ◽  
Level I

Previous investigations suggest outcome differences at Level I and Level II trauma centers. We examined use of intracranial pressure (ICP) monitors at Level I and Level II trauma centers after traumatic brain injury (TBI) and its effect on mortality. The 2007 to 2008 National Trauma Databank was reviewed for patients with an indication for ICP monitoring based on Brain Trauma Foundation (BTF) guidelines. Demographic and clinical outcomes at Level I and Level II centers were compared by regression modeling. Overall, 15,921 patients met inclusion criteria; 11,017 were admitted to a Level I and 4,904 to a Level II trauma center. Patients with TBI admitted to a Level II trauma center had a lower rate of Injury Severity Score greater than 16 (80 vs 82%, P < 0.01) and lower frequency of head Abbreviated Injury Score greater than 3 (80 vs 82%, P < 0.01). After regression modeling, patients with TBI admitted to a Level II trauma center were 31 per cent less likely to receive an ICP monitor (adjusted odds ratio [AOR], 0.69; P < 0.01) and had a significantly higher mortality (AOR, 1.12; P < 0.01). Admission to a Level II trauma center after severe TBI is associated with a decreased use of ICP monitoring in patients who meet BTF criteria as well as an increased mortality. These differences should be validated prospectively to narrow these discrepancies in care and outcomes between Level I and Level II centers.

Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis

2016 ◽  
Vol 51 (3) ◽  
pp. 499-502 ◽  
Author(s):  
Arash Safavi ◽  
Erik D. Skarsgard ◽  
Peter Rhee ◽  
Bardiya Zangbar ◽  
Narong Kulvatunyou ◽  
...  
Keyword(s):  
Trauma Center ◽  
Pediatric Patients ◽  
Data Bank ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
National Trauma ◽  
National Trauma Data Bank

scholarly journals Helicopter Emergency Medical Service and Hospital Treatment Levels Affect Survival in Pediatric Trauma Patients

2021 ◽  
Vol 10 (4) ◽  
pp. 837
Author(s):  
Felix Marius Bläsius ◽  
Klemens Horst ◽  
Jörg Christian Brokmann ◽  
Rolf Lefering ◽  
Hagen Andruszkow ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Pediatric Patients ◽  
Pediatric Trauma ◽  
Helicopter Emergency Medical Service ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Emergency Medical ◽  
Level Ii ◽  
Level I

(1) Background: Data on the effects of helicopter emergency medical service (HEMS) transport and treatment on the survival of severely injured pediatric patients in high-level trauma centers remain unclear. (2) Methods: A national dataset from the TraumaRegister DGU® was used to retrospectively compare the mortality rates among severely injured pediatric patients (1–15 years) who were transported by HEMS to those transported by ground emergency medical service (GEMS) and treated at trauma centers of different treatment levels (levels I–III). (3) Results: In total, 2755 pediatric trauma patients (age: 9.0 ± 4.8 years) were included in this study over five years. Transportation by HEMS resulted in a significant survival benefit compared to GEMS (odds ratio (OR) 0.489; 95% confidence interval (CI): 0.282–0.850). Pediatric trauma patients treated in level II or III trauma centers showed 34% and fourfold higher in-hospital mortality risk than those in level I trauma centers (level II: OR 1.34, 95% CI: 0.70–2.56; level III: OR 4.63, 95% CI: 1.33–16.09). (4) Conclusions: In our national pediatric trauma cohort, both HEMS transportation and treatment in level I trauma centers were independent factors of improved survival in pediatric trauma patients.

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