Temporal trends in patient characteristics, injury mechanisms and outcomes in pediatric trauma admissions between 2010 and 2017

• Published in: The American journal of surgery Vol. 220; no. 2; pp. 468 - 475
• Main Authors: Mansuri, Fahad, Loux, Tara, Brooks, Sandra E., Slye, Nicole, Lu, Yuanyuan, Lewis, Briana, Chen, Henian, Kip, Kevin E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2020; Elsevier Limited
• Subjects: Aircraft accidents; Animal bites; Children; Clinical outcomes; Complications; Confidence intervals; Epidemiology; Head injuries; Health risks; Helicopters; Injuries; Injury prevention; Morbidity; Pediatric; Pediatrics; Prevention; Regression analysis; Risk analysis; Risk factors; Statistical analysis; Temporal trends. modifiable risk factors; Trauma; Trauma centers; Trauma registry; Trends; Trauma registry; Temporal trends. modifiable risk factors; Pediatric; Epidemiology; Injuries
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.11.041

Injuries are a leading cause of preventable morbidity and mortality in children. Mechanisms of injuries and presentations are diverse in pediatric injuries and require special attention. Dedicated pediatric trauma care centers are ideal for management of children with injuries simultaneously serving as sources of research data. The objective of the current study was to identify changes in injury mechanisms, modifiable risk factors, and outcomes independently associated with admissions at a large pediatric trauma center in Tampa, Florida.
We conducted retrospective analysis of 8-years (2010-2017) of pediatric trauma admissions to a large trauma center. Demographic factors and injury characteristics were examined for temporal trends over two year increments. Temporal changes in admissions with major trauma, admission to ICU, and length of stay were examined using logistic regression analysis, and factors associated with independent temporal trends were identified using ordinal logistic regression modeling.
During the study period, there were 4,934 trauma admissions with a predominance of falls (45.1%) and traffic injuries (20.5%). Trends were observed with less frequent head injuries (2010-2011: 35.7% vs 2016-2017: 28.3%, p < .01) and abdominal injuries (2010-2011:10.3% vs 2016-2017: 8.2%, p = .03), and more frequent chest injuries (2010-2011: 9.0% vs 2016-2017: 11.4%, p < .01). Over the study period, evaluated in 2-year increments, higher use of private insurance (Adjusted Odds Ratio (AOR)=1.44, 95% Confidence Interval (CI) 95% CI: 1.29-1.61) and helicopter transport (AOR=1.91, 95% CI: 1.58 -2.30) was observed. Admissions for drownings (AOR=1.50, 95% CI: 1.10 -2.02) and animal bites (AOR=1.99, 95% CI: 1.46 -2.71) increased during the study period. Improvement in patient outcomes (adjusted for injury severity) were observed with shorter, ≤1 day length of stay (LOS) (AOR=1.19, 95% CI: 1.06 -1.33), reduction in complications (AOR=0.47, 95% CI: 0.33 -0.66), and more admissions without an intensive care unit (ICU) stay (AOR=1.6 95% CI = 1.36 -1.88).
Significant reductions in LOS, ICU stay, and complications were temporally observed despite an increase in admissions with higher use of helicopter transport. These results can most likely be attributed to dedicated pediatric trauma experts and resources available at an integrated pediatric trauma center.
•Temporal Trends were observed at a large pediatric trauma center between 2010 and 2017.•Drowning and animal bite admissions increased during the study period.•Overall Length of stay, ICU admissions and complication rates reduced.•Trends in major trauma, ICU stay, and LOS differed by injury mechanisms.
Pediatric trauma registries are a fundamental tool. Independent temporal trends were observed over an eight-year period at a large pediatric trauma center with increase in admissions due to drowning and animal bites. Improvements were seen in length of stay; complication rates and ICU stay.