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Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?

https://doi.org/10.1016/j.jpedsurg.2007.09.047Get rights and content

Abstract

Objective

The purposes of the study were to compare the survival associated with treatment of seriously injured patients with pediatric trauma in Florida at designated trauma centers (DTCs) with nontrauma center (NCs) acute care hospitals and to evaluate differences in mortality between designated pediatric and nonpediatric trauma centers.

Methods

Trauma-related inpatient hospital discharge records from 1995 to 2004 were analyzed for children aged from 0 to 19 years. Age, sex, ethnicity, injury mechanism, discharge diagnoses, and severity as defined by the International Classification Injury Severity Score were analyzed, using mortality during hospitalization as the outcome measure. Children with central nervous system, spine, torso, and vascular injuries and burns were evaluated. Instrumental variable analysis was used to control for triage bias, and mortality was compared by probabilistic regression and bivariate probit modeling. Children treated at a DTC were compared with those treated at a nontrauma center. Within the population treated at a DTC, those treated at a DTC with pediatric capability were compared with those treated at a DTC without additional pediatric capability. Models were analyzed for children aged 0 to 19 years and 0 to 15 years.

Results

For the 27,313 patients between ages 0 and 19 years, treatment in DTCs was associated with a 3.15% reduction in the probability of mortality (P < .0001, bivariate probit). The survival advantage for children aged 0 to 15 years was 1.6%, which is not statistically significant. Treatment of 16,607 children in a designated pediatric DTC, as opposed to a nonpediatric DTC, was associated with an additional 4.84% reduction in mortality in the 0- to 19-year age group and 4.5% in the 0 to 15 years group (P < .001, bivariate probit).

Conclusions

Optimal care of the seriously injured child requires both the extensive and immediate resources of a DTC as well as pediatric-specific specialty support.

Section snippets

The Florida Trauma System

The first legislation concerning the Florida Trauma System was enacted in 1982 and required the Department of Health and Rehabilitative Services to verify that DTCs met established guidelines. Florida's trauma laws and regulations were further developed and expanded in 1987 and 1990. By 2004, the Florida Department of Health designated 20 hospitals as DTCs. These included 6 Level I, 12 Level II, and 2 pediatric trauma centers (PDTCs). All 6 Level I and 4 Level II trauma centers also met medical

Methods

Florida AHCA inpatient discharge data sets from 1995 to 2004 were analyzed. These data sets contain information concerning patient demographic and case-mix–related characteristics, such as age, sex, race, type of diagnosis, source of admission, and discharge status. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify a study population consisting of 5 groups of patients with trauma who sustained (a) fractures (of the skull, neck, and

Results

Table 2 lists the demographic and mortality distributions of patients. The number of pediatric patients with trauma, aged 0 to 19 years, included in the overall analysis was 27,313. Approximately 60% of these children were treated in a DTC. A little more than 46% were transported to a PDTC. The overall mortality rate of pediatric patients with trauma was 3.22% but increased to 4.23% when only DTC-treated pediatric patients were included. The rate increased slightly to 4.39% when the population

Discussion

The efficacy of systems of trauma care in saving lives and preserving quality of life is now well established and validated [1], [2], [3], [4], [5], [6], [7]. How these advances in systems of care apply to children is still not completely defined, especially with regard to the concept of institutional qualifications. Children's hospitals exist for the sole purpose of providing a full range of child-specific resources for every patient. Trauma centers, which often are not collocated with

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Presented at the 38th annual meeting of the American Pediatric Surgical Association, Orlando, Florida, May 24-27, 2007.

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