Highlights
- •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.
Abstract
Introduction
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.
Methods
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.
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: January 06, 2020
Accepted:
November 4,
2019
Received in revised form:
October 23,
2019
Received:
July 10,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
