Impact of trauma system development on pediatric injury care
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ORIGINAL ARTICLE
Impact of trauma system development on pediatric injury care David P. Mooney • Ivan M. Gutierrez • Qiaoli Chen • Peter W. Forbes • David Zurakowski
Accepted: 4 December 2012 / Published online: 18 December 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose Trauma systems improve survival by directing severely injured patients to trauma centers. This study analyzes the impact of trauma systems on pediatric triage and injury mortality rates. Methods Population-based data were collected on injured children less than 15 years who were admitted to any hospital in New England from 1996 to 2006. Data from three trauma system states were compared to three nontrauma system states. The percentages of injured children, severely injured children, and brain-injured children admitted to trauma centers were determined as well as injury hospitalization and death rates. Time trend analysis examined the pace of change between the groups. Results A total of 58,583 injured children were hospitalized during the study period. Injury hospitalization rates were initially similar between the two groups (with and without trauma systems) and decreased over time in both. Rates decreased more rapidly in trauma system states compared to those without, (P = 0.003). Injury death rates decreased over time in both groups with no difference between the groups, (P = 0.20). A higher percentage of injured children were admitted to trauma centers in nontrauma system states throughout the study period, and this percentage increased in both groups of states. A higher percentage of severely injured children and brain-injured D. P. Mooney (&) I. M. Gutierrez D. Zurakowski Trauma Program, Department of Surgery, Children’s Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Fegan 3, Boston, MA 02115, USA e-mail: [email protected] Q. Chen P. W. Forbes Clinical Research Program, Children’s Hospital Boston, Boston, MA, USA
children were admitted to trauma centers in non-trauma system states and both percentages increased over time. The increase was more rapid in trauma system states for children with severe injuries (P \ 0.001) and children with brain injuries (P \ 0.001). Discussion Trauma systems decreased childhood injury hospitalization rates and increased the percentage of severely injured children and brain-injured children admitted to trauma centers. Mortality and overall triage rates were unaffected. Keywords Trauma Pediatric Triage Outcome assessment
Introduction State and regional trauma systems have evolved in North America in an attempt to improve the outcome of patients with traumatic injuries. Trauma systems are organized public health efforts across a state or region to deliver care to injured patients in a coordinated way. One of their many functions is to direct patients to the most appropriate facility, diverting severely injured patients away from nontrauma centers to trauma centers, where survival has been shown to be significantly better. Several published studies have
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