Impact of Pediatric Trauma Centers on Mortality in a Statewide System

Potoka, Douglas A.; Schall, Laura; Gardner, Mary J.; Stafford, Perry W.; Peitzman, Andrew B.; Ford, Henri R.

doi:10.1097/00005373-200008000-00009

Cited by 316 publications

(176 citation statements)

References 16 publications

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“…These results agree with prior reports of decreased hospitalization and mortality associated with pediatric trauma center designation [6,11,27]. These effects may be due to a more focused initial trauma assessment, resuscitation and recovery for injured children.…”

Section: Discussionsupporting

confidence: 90%

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Academic-community partnerships improve outcomes in pediatric trauma care

Kelley-Quon¹,

Crowley²,

Applebaum³

et al. 2015

Journal of Pediatric Surgery

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a b s t r a c t a r t i c l e i n f oBackground: To address the specialized needs of injured children, pediatric trauma centers (PTCs) were established at many large, academic hospitals. This study explores clinical outcomes observed for injured children treated at an academic-sponsored community facility. Methods: In partnership with an academic medical center in a major metropolitan area, a not-for-profit community hospital became a designated Level II PTC in October 2010. Data for injured children b15 years old treated prior to PTC designation from January 2000 to September 2010 were prospectively collected using the Trauma and Emergency Medicine Information System and compared to data collected after PTC designation from January 2011 to December 2013. Results: Overall, 681 injured children were treated at the community hospital from January 2011 to December 2013. Children treated after PTC designation were less likely to undergo computed tomography (CT) (50.9% vs. 81.3%, p b 0.01), even when controlling for age, gender, injury type, injury severity, and year (OR 0.18, 95%CI 0.08-0.37). Specifically, fewer head (45.7% vs. 68.7%, p b 0.01) and abdominal CTs (13.2% vs. 26.5%, p b 0.01) were performed. Hospital length of stay was significantly shorter (2.8 ± 3.7 days vs. 3.7 ± 5.9 days, p b 0.01). Mortality was low overall, but also decreased after PTC designation (0.4% vs. 2.0%, p = 0.02). Conclusions: These results indicate that academic-community partnerships in pediatric trauma care are a feasible alternative and may lead to improved outcomes for injured children.

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Section: Discussionsupporting

confidence: 90%

“…For example, injured children treated at an adult hospital with a pediatric trauma unit may have similarly improved outcomes compared to those treated at a free-standing PTC [9][10][11]. Thus, broader definitions of alternative pediatric-specific trauma systems could bridge disparities in pediatric trauma care delivery in the United States.…”

mentioning

confidence: 99%

Academic-community partnerships improve outcomes in pediatric trauma care

Kelley-Quon¹,

Crowley²,

Applebaum³

et al. 2015

Journal of Pediatric Surgery

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“…2,5,7,18,21,23 These patients' still-maturing CNS responds differently to injury and the current treatments available, making it imperative to determine the best course of action to improve outcomes in this population. 5,16,18,22 The 2003 Brain Trauma Foundation guidelines, 5 which were most recently updated in 2012, 14 summarized practice standards for treatment of severe TBI in children. The overarching goal of critical care in treating TBI is to reduce secondary brain injury by limiting cerebral ischemia and optimizing cerebral blood flow.…”

mentioning

confidence: 99%

Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge

O'Lynnger¹,

Shannon²,

Le³

et al. 2016

Journal of Neurosurgery: Pediatrics

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OBJECT The goal of critical care in treating traumatic brain injury (TBI) is to reduce secondary brain injury by limiting cerebral ischemia and optimizing cerebral blood flow. The authors compared short-term outcomes as defined by discharge disposition and Glasgow Outcome Scale scores in children with TBI before and after the implementation of a protocol that standardized decision-making and interventions among neurosurgeons and pediatric intensivists. METHODS The authors performed a retrospective pre- and postprotocol study of 128 pediatric patients with severe TBI, as defined by Glasgow Coma Scale (GCS) scores < 8, admitted to a tertiary care center pediatric critical care unit between April 1, 2008, and May 31, 2014. The preprotocol group included 99 patients, and the postprotocol group included 29 patients. The primary outcome of interest was discharge disposition before and after protocol implementation, which took place on April 1, 2013. Ordered logistic regression was used to assess outcomes while accounting for injury severity and clinical parameters. Favorable discharge disposition included discharge home. Unfavorable discharge disposition included discharge to an inpatient facility or death. RESULTS Demographics were similar between the treatment periods, as was injury severity as assessed by GCS score (mean 5.43 preprotocol, mean 5.28 postprotocol; p = 0.67). The ordered logistic regression model demonstrated an odds ratio of 4.0 of increasingly favorable outcome in the postprotocol cohort (p = 0.007). Prior to protocol implementation, 63 patients (64%) had unfavorable discharge disposition and 36 patients (36%) had favorable discharge disposition. After protocol implementation, 9 patients (31%) had unfavorable disposition, while 20 patients (69%) had favorable disposition (p = 0.002). In the preprotocol group, 31 patients (31%) died while 6 patients (21%) died after protocol implementation (p = 0.04). CONCLUSIONS Discharge disposition and mortality rates in pediatric patients with severe TBI improved after implementation of a standardized protocol among caregivers based on best-practice guidelines.

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“…79 Pediatric patients with severe TBI have poorer survival rates if they are treated at Level II adult trauma centers. 123 …”

Section: Transport Destinationmentioning

confidence: 99%

Prehospital management of traumatic brain injury

Stiver¹,

Manley²

2008

FOC

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The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

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Impact of Pediatric Trauma Centers on Mortality in a Statewide System

Cited by 316 publications

References 16 publications

Academic-community partnerships improve outcomes in pediatric trauma care

Academic-community partnerships improve outcomes in pediatric trauma care

Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge

Prehospital management of traumatic brain injury

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