Differences in survival outcome for severely injured paediatric trauma by type of trauma centre

Mitchell, Robert J.; Curtis, Kate; Testa, Luke; Holland, A.J.A.; Soundappan, Soundappan Sv; Adams, Sarah

doi:10.1111/jpc.13514

Cited by 10 publications

(13 citation statements)

References 18 publications

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“…This is consistent with the findings of Miyata et al, which showed survival benefits for pediatric trauma patients in high-volume trauma centers in a cohort of over 3700 children with ISS greater than 25 [28]. These results have been confirmed by several studies, underlining the survival benefits of specialized pediatric trauma centers [10,11,29,30]. Interestingly, Brown et al included in-hospital confounders, such as trauma center type, and demonstrated a two-fold increase in survival for treatment in level I compared to level II pediatric trauma centers [8].…”

Section: Discussionsupporting

confidence: 91%

Helicopter Emergency Medical Service and Hospital Treatment Levels Affect Survival in Pediatric Trauma Patients

Bläsius

Horst

Brokmann³

et al. 2021

JCM

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(1) Background: Data on the effects of helicopter emergency medical service (HEMS) transport and treatment on the survival of severely injured pediatric patients in high-level trauma centers remain unclear. (2) Methods: A national dataset from the TraumaRegister DGU® was used to retrospectively compare the mortality rates among severely injured pediatric patients (1–15 years) who were transported by HEMS to those transported by ground emergency medical service (GEMS) and treated at trauma centers of different treatment levels (levels I–III). (3) Results: In total, 2755 pediatric trauma patients (age: 9.0 ± 4.8 years) were included in this study over five years. Transportation by HEMS resulted in a significant survival benefit compared to GEMS (odds ratio (OR) 0.489; 95% confidence interval (CI): 0.282–0.850). Pediatric trauma patients treated in level II or III trauma centers showed 34% and fourfold higher in-hospital mortality risk than those in level I trauma centers (level II: OR 1.34, 95% CI: 0.70–2.56; level III: OR 4.63, 95% CI: 1.33–16.09). (4) Conclusions: In our national pediatric trauma cohort, both HEMS transportation and treatment in level I trauma centers were independent factors of improved survival in pediatric trauma patients.

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Section: Discussionsupporting

confidence: 91%

Helicopter Emergency Medical Service and Hospital Treatment Levels Affect Survival in Pediatric Trauma Patients

Bläsius

Horst

Brokmann³

et al. 2021

JCM

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“…89e91 Mature trauma systems have integrated paediatric-specific guidelines, and designated paediatric trauma centres, with an attributable survival benefit for children and adolescents. 90,92 Despite paediatric patients featuring significantly in MCIs, 47,93,94 most research has investigated the disaster preparedness of trauma centres in the adult setting. Paediatric patients have been considered at increased risk of adverse outcomes because of their anatomy and physiology.…”

Section: Post-disaster Recoverymentioning

confidence: 99%

Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?

Gabbe¹,

Veitch²,

Mather³

et al. 2022

British Journal of Anaesthesia

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Mass casualty incidents (MCIs) are diverse, unpredictable, and increasing in frequency, but preparation is possible and necessary. The nature of MCIs requires a trauma response but also requires effective and tested disaster preparedness planning. From an international perspective, the aims of this narrative review are to describe the key components necessary for optimisation of trauma system preparedness for MCIs, whether trauma systems and centres meet these components and areas for improvement of trauma system response. Many of the principles necessary for response to MCIs are embedded in trauma system design and trauma centre function. These include robust communication networks, established triage systems, and capacity to secure centres from threats to safety and quality of care. However, evidence from the current literature indicates the need to strengthen trauma system preparedness for MCIs through greater trauma leader representation at all levels of disaster preparedness planning, enhanced training of staff and simulated disaster training, expanded surge capacity planning, improved staff management and support during the MCI and in the post-disaster recovery phase, clear provision for the treatment of paediatric patients in disaster plans, and diversified and pre-agreed systems for essential supplies and services continuity. Mass casualty preparedness is a complex, iterative process that requires an integrated, multidisciplinary, and tiered approach. Through effective preparedness planning, trauma systems should be well-placed to deliver an optimal response when faced with MCIs.

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“…In 2010, a retrospective review of 1138 severely injured children using data from the NSW Trauma Registry, children who received definitive treatment at a PTC were between 3 and 6 times more likely to survive than if they were treated at an ATC [3] . A repeat study in 2017 had similar findings [4] . The reasons for the finding of a survival benefit at a PTC were unclear.…”

Section: Introductionmentioning

confidence: 62%

Cause, treatment costs and 12-month functional outcomes of children with major injury in NSW, Australia

Curtis

Kennedy

Lam

et al. 2020

Injury

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Background: Information about children treated in New South Wales (NSW), Australia following major injury has been limited to those treated at trauma centres using mortality as the main outcome measure, restricting assessment of the effectiveness of the Trauma System. This study sought to describe the detailed characteristics as well as functional and psychosocial health outcomes of all children suffering major injury in NSW.Methods: A longitudinal study was conducted between July 2015 and November 2017 and included children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW or who died following injury. Children were identified through the three NSW Paediatric Trauma Centres (PTC), the NSW Trauma Registry, NSW Aeromedical Retrieval Registry (AirMaestro) and the National Coronial Information System (NCIS). Health-related quality of life (HRQoL) outcomes for children treated at the three PTCs were collected at baseline, 6 and 12 months using the Paediatric Quality of Life inventory (PedsQL 4.0) and EuroQol five-dimensional EQ-5D-Y.Results: There were 625 children, with a median (interquartile range) age of 7 (2-13) years and 71.7% were male. Around half were injured in major cities (51.2%). The median (IQR) injury severity score (ISS) was 10 (9-17). Twelve-month HRQoL measured by PedsQL remained below baseline for psychosocial health. Treatment costs increased with injury severity ( p = < 0.001) and polytrauma ( p = < 0.001). No survival benefit was demonstrated between PTC versus non-PTC definitive care. Injured females and children from rural / remote NSW were overrepresented in the deceased. Conclusion:Children treated in NSW following major injury have reduced quality of life and in particular, reduced emotional well-being at 12 months post-injury. Improved psychosocial care and outpatient follow-up is required to minimise the long-term emotional impact of injury on the child.

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Differences in survival outcome for severely injured paediatric trauma by type of trauma centre

Cited by 10 publications

References 18 publications

Helicopter Emergency Medical Service and Hospital Treatment Levels Affect Survival in Pediatric Trauma Patients

Helicopter Emergency Medical Service and Hospital Treatment Levels Affect Survival in Pediatric Trauma Patients

Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?

Cause, treatment costs and 12-month functional outcomes of children with major injury in NSW, Australia

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