Pediatric Trauma System Evaluation before and after Level II Verification

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

The American Surgeon ◽

10.1177/000313481508101003 ◽

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.

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

The American Surgeon ◽

10.1177/00031348211033535 ◽

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.

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

PEDIATRICS ◽

10.1542/peds.84.4.694 ◽

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.

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Development, Validation, and Implementation of a Guideline to Improve Clinical Event Debriefing at a Level-I Adult and Level-II Pediatric Trauma Center

Journal of Emergency Nursing ◽

10.1016/j.jen.2021.04.013 ◽

2021 ◽

Author(s):

Steven Phillip Tyler ◽

Jane Dixon ◽

Janet Parkosewich ◽

Paul C. Mullan ◽

Amish Aghera

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Clinical Event ◽

Level Ii ◽

Level I ◽

Pediatric Trauma Center

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

The American Surgeon ◽

10.1177/000313481207801034 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1166-1171 ◽

Cited By ~ 5

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.

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