- •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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Peden M.M. UNICEF World Health Organization World Report on Child Injury Prevention. World Health Organization ; UNICEF, Geneva, Switzerland : [New York, NY2008
- CDC Childhood Injury Report: Patterns of Unintentional Injuries Among 0-19 Year Olds in the United States, 2000-2006.2008https://doi.org/10.1037/e572462009-001 (572462009-001)
- Altered stress system reactivity after pediatric injury: relation with post-traumatic stress symptoms.Psychoneuroendocrinology. 2017; 84: 66-75https://doi.org/10.1016/j.psyneuen.2017.06.003
- History and development of trauma registry: lessons from developed to developing countries.World J Emerg Surg. 2006; 1: 32https://doi.org/10.1186/1749-7922-1-32
- Strategies for successful trauma registry implementation in low- and middle-income countries-protocol for a systematic review.Syst Rev. 2018; 7: 33https://doi.org/10.1186/s13643-018-0700-2
- Implementing the national priorities for injury surveillance.Med J Aust. 2008; 188: 405-408https://doi.org/10.5694/j.1326-5377.2008.tb01685.x
- American community Survey (ACS).(Accessed)https://www.census.gov/programs-surveys/acsDate accessed: November 26, 2018
- The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.J Trauma. 1974; 14: 187-196
- The injury severity score revisited.J Trauma. 1988; 28: 69-77
- An overview of the injury severity score and the new injury severity score.Inj Prev. 2001; 7: 10-13https://doi.org/10.1136/ip.7.1.10
Palmer C. MAJOR TRAUMA AND THE INJURY SEVERITY SCORE - WHERE SHOULD WE SET THE BAR? :17.
- Unintentional injury deaths among persons aged 0–19 Years — United States, 2000–2009.https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6115a5.htmDate accessed: January 31, 2019
- Gender disparities in injury mortality: consistent, persistent, and larger than you’d think.Am J Public Health. 2011; 101: S353-S358https://doi.org/10.2105/AJPH.2010.300029
- An Evidence-based Guideline for the air medical transportation of prehospital trauma patients.Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2014; 18: 35-44https://doi.org/10.3109/10903127.2013.844872
- Mode of transport and clinical outcome in rural trauma: a helicopter versus ambulance comparison.Am Surg. 2017; 83: 1413-1417
- WISQARS (Web-based injury statistics query and reporting System)|Injury Center|CDC.(Published)https://www.cdc.gov/injury/wisqars/index.html(January 31, 2019)Date: January 18, 2019
- An analysis of pediatric gunshot wounds treated at a Level I pediatric trauma center.J Trauma. 2003; 54: 1102-1106https://doi.org/10.1097/01.TA.0000063479.92520.2E
- Childhood firearm injuries in the United States.Pediatrics. 2017; 140e20163486https://doi.org/10.1542/peds.2016-3486
- National action plan for child injury prevention | child safety and injury Prevention| CDC injury center.https://www.cdc.gov/safechild/nap/index.htmlDate accessed: January 31, 2019
- Evolution of a level I pediatric trauma center: changes in injury mechanisms and improved outcomes.Surgery. 2018; 163: 1173-1177https://doi.org/10.1016/j.surg.2017.10.070
- The effect of verified pediatric trauma centers, state laws, and crash characteristics on time trends in adolescent motor vehicle fatalities, 1999-2015.J Trauma Acute Care Surg. 2018; 85: 944-952https://doi.org/10.1097/TA.0000000000001972
- “Adult” trauma surgeons with pediatric commitment: a logical solution to the pediatric trauma manpower problem.Am Surg. 1995; 61: 968-974
- Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?.J Pediatr Surg. 2008; 43: 212-221https://doi.org/10.1016/j.jpedsurg.2007.09.047
- Impact of pediatric trauma centers on mortality in a statewide system.J Trauma Inj Infect Crit Care. 2000; 49: 237-245https://doi.org/10.1097/00005373-200008000-00009
- Outcomes and delivery of care in pediatric injury.J Pediatr Surg. 2006; 41: 92-98https://doi.org/10.1016/j.jpedsurg.2005.10.013
- Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system.J Emergencies, Trauma, Shock. 2011; 4: 12-19https://doi.org/10.4103/0974-2700.76824
- Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system.Ann Surg. 2012; 255: 1009https://doi.org/10.1097/SLA.0b013e31824c4b91
- Measurable outcomes of quality improvement in the trauma intensive care unit: the impact of a daily quality rounding checklist.J Trauma Acute Care Surg. 2008; 64: 22https://doi.org/10.1097/TA.0b013e318161b0c8
Published online: January 06, 2020
Accepted: November 4, 2019
Received in revised form: October 23, 2019
Received: July 10, 2019
© 2020 Elsevier Inc. All rights reserved.