Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care?

• Published in: The American journal of surgery Vol. 201; no. 4; pp. 445 - 449
• Main Authors: Oyetunji, Tolulope A., M.D., M.P.H, Haider, Adil H., M.D., M.P.H., F.A.C.S, Downing, Stephanie R., M.D, Bolorunduro, Oluwaseyi B., M.D., M.P.H, Efron, David T., M.D., F.A.C.S, Haut, Elliott R., M.D., F.A.C.S, Chang, David C., M.P.H., M.B.A., Ph.D, Cornwell, Edward E., M.D., F.A.C.S, Abdullah, Fizan, M.D., Ph.D., F.A.C.S, Siram, Suryanarayana M., M.D., F.A.C.S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2011; Elsevier; Elsevier Limited
• Subjects: Adolescent; Age; Biological and medical sciences; Bivariate analysis; Child; Child Health Services - organization & administration; Child, Preschool; Children; Coma; Confidence intervals; Databases, Factual; Demographics; Emergency services; Female; Firearms; General aspects; Glasgow Coma Scale; Humans; Injuries; Injury analysis; Injury Severity Score; Male; Medical sciences; Morbidity; Mortality; Multivariate analysis; Patients; Pediatric; Pediatrics; Pediatrics - organization & administration; Pediatrics - statistics & numerical data; Surgery; Survival Analysis; Trauma; Trauma care; Trauma center; Trauma centers; Trauma Centers - organization & administration; Trauma Centers - statistics & numerical data; Treatment Outcome; United States - epidemiology; Wounds and Injuries - mortality; Wounds and Injuries - therapy; United States; United States > US; Pediatric; Trauma; Trauma center; Human; Pediatrics; Center; Prognosis; Care; Medicine; Treatment; Surgery; Adult; Evolution; Child
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.10.006

Abstract Background Accidental traumatic injury is the leading cause of morbidity and mortality in children. The authors hypothesized that no mortality difference should exist between children seen at ATC (adult trauma centers) versus ATC with added qualifications in pediatrics (ATC-AQ). Methods The National Trauma Data Bank, version 7.1, was analyzed for patients aged <18 years seen at level 1 trauma centers. Bivariate analysis compared patients by ATC versus ATC-AQ using demographic and injury characteristics. Multivariate analysis adjusting for injury and demographic factors was then performed. Results A total sample of 53,702 children was analyzed, with an overall mortality of 3.9%. The adjusted odds of mortality was 20% lower for children seen at ATC-AQ (odds ratio, .80; 95% confidence interval, .68–.94). Children aged 3 to 12 years, those with injury severity scores > 25, and those with Glasgow Coma Scale scores < 8 all had significant reductions in the odds of death at ATC-AQ. Conclusions Improved overall survival is associated with pediatric trauma patients treated at ATC-AQ.