Outcomes and delivery of care in pediatric injury

Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Journal of Pediatric Surgery (Impact Factor: 1.39). 02/2006; 41(1):92-8; discussion 92-8. DOI: 10.1016/j.jpedsurg.2005.10.013
Source: PubMed


To design effective pediatric trauma care delivery systems, it is important to correlate site of care with corresponding outcomes. Using a multistate administrative database, we describe recent patient allocation and outcomes in pediatric injury.
The 2000 Kids' Inpatient Database, containing 2,516,833 inpatient discharge records from 27 states, was filtered by E-code to yield pediatric injury cases. Injury Severity Scores (ISSs) were derived for each discharge using ICDMAP-90 (Tri-Analytics, Inc, Forest Hill, MD). After weighting to estimate national trends, cases were grouped by age (0-10, >10-20 years), ISS (< or =15, >15), and National Association of Children's Hospitals and Related Institutions-designated site of care. Measured outcomes included mortality, length of stay, and total charges. Analysis was completed using Student's t test and chi2.
Among 79,673 injury cases, mean age was 12.2 +/- 6.2 years and ISS was 7.4 +/- 7.6. Eighty-nine percent of injured children received care outside of children's hospitals. In the subgroup of patients aged 0 to 10 years with ISS of greater than 15, the mean ISS for adult hospitals and children's hospitals was not significantly different (18.9 +/- 9.1 vs. 19.4 +/- 9.3, P = .08). However, in-hospital mortality, length of stay, and charges were all significantly higher in adult hospitals (P < .0001).
Younger and more seriously injured children have improved outcomes in children's hospitals. Appropriate triage may improve outcomes in pediatric trauma.


Available from: John C Densmore
  • Source
    • "On the other hand, pediatric trauma centers (PTCs) are specifically equipped and staffed with specialty-trained caregivers to provide optimal care for injured children (American College of Surgeons Committee on Trauma 2006). While some authors dispute outcome differences between ATCs and PTCs (Fortune et al. 1992; Jubelirer et al. 1990; Kaufmann et al. 1989; Knudson et al. 1992; Osler et al. 2001; Rhodes et al. 1993), other studies have demonstrated improvement in morbidity and mortality when pediatric trauma patients are treated at PTCs (Densmore et al. 2006; Mooney et al. 2006; Potoka et al. 2001; Pracht et al. 2008). Due to the shortage of PTCs as well as geographic distributions limiting access to care at PTCs in many areas of the country (Nance et al. 2009), the majority of pediatric trauma patients in the U.S. receive care at ATCs (Segui-Gomez et al. 2003). "

    01/2014; 1(1):15. DOI:10.1186/2197-1714-1-15
  • Source
    • "It has been shown that improved hospital care results in lower mortality and that care is best delivered at a paediatric trauma centre [11]. Therefore the identification of high-risk injury patterns may lead to improved care and ultimately further improvements in outcome in children admitted to hospital with trauma [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Injuries continue to be the leading cause of death and disability for children. The is a paucity of published data on paediatric injuries in our local environment. This study describes the etiological spectrum, injury characteristics and treatment outcome of paediatric injuries in our local setting and provides baseline data for establishment of prevention strategies as well as treatment guidelines. This was a descriptive cross-sectional study involving paediatric injury patients admitted to Bugando Medical Centre from August 2011 to April 2012. Statistical data analysis was done using SPSS version 17.0 and STATA version 12.0. A total of 150 patients were studied. The age of patients ranged from 1 month to 10 years with a median age of 5 years. The male to female ratio was 2.3:1. Road traffic accident was the most common cause of injury (39.3%) and motorcycle (71.2%) was responsible for the majority of road traffic accidents. Only 11 (7.3%) patients received pre-hospital care. The head /neck (32.7%) and musculoskeletal (28.0%) were the most frequent body region injured. Open wounds (51.4%), foreign bodies (31.3%) and fractures (17.3%) were the most common type of injuries sustained. The majority of patients 84 (56.0%) were treated surgically. Complication rate was 3.9%. The mean duration of hospitalization was 9.7 ± 13.1 days. Mortality rate was 12.7%. Age of the patient (< 5 years), late presentation and presence of complications were the main predictors of length of hospital stay (P < 0.001), whereas burn injuries, severe head injuries and severity of injury (Paediatric trauma score = 0-5) significantly predicted mortality (P < 0.0001). Paediatric injuries resulting from road traffic accidents (RTAs) remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of paediatric injuries in this region.
    Journal of Trauma Management & Outcomes 11/2013; 7(1):10. DOI:10.1186/1752-2897-7-10
  • Source
    • "Trauma is the leading cause of death in children [1] [2], and trauma systems have been shown to decrease mortality [3] [4] [5] [6] [7]. Time to definitive trauma care is now recognised as a key determinant of outcome [8] [9] [10] [11] [12] and is facilitated by triage of casualties to appropriately resourced facilities [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Trauma systems reduce mortality and improve functional outcomes. The aim of this study was to analyse the demographic and geospatial characteristics of pediatric trauma patients in Scotland, and determine the level of destination healthcare facility which injured children are taken to, to determine the need for, and general feasibility, of developing a pediatric trauma system for Scotland. Retrospective analysis of incidents involving children aged 1-14 attended to by the Scottish Ambulance Service between 1 November 2008 and 31 October 2010. A subgroup with physiological derangement was defined. Incident location postcode was used to determine incident location by health board region, rurality and social deprivation. Destination healthcare facility was classified into one of six categories. Of 10,759 incidents, 72.3% occurred in urban areas and 5.8% in remote areas. Incident location was associated with socioeconomic deprivation. Of the patients, 11.6% were taken to a pediatric hospital with pediatric intensive care facilities, 21.8% to a pediatric hospital without pediatric intensive care service, and 50.2% to an adult large general hospital without pediatric surgical service. The majority of incidents involving children with injuries occurred in urban areas. Half were taken to a hospital without pediatric surgical service. There was no difference between children with normal and deranged physiology.
    Journal of Pediatric Surgery 07/2013; 48(7):1593-7. DOI:10.1016/j.jpedsurg.2013.03.060 · 1.39 Impact Factor
Show more