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A National Analysis of Pediatric Trauma Care Utilization and Outcomes in the United States

Myers, Sage R., MD, MSCE*†; Branas, Charles C., PhD; French, Benjamin, PhD; Nance, Michael L., MD‡§; Carr, Brendan G., MD, MS∥¶

doi: 10.1097/PEC.0000000000000902
Original Articles

Objectives More childhood deaths are attributed to trauma than all other causes combined. Our objectives were to provide the first national description of the proportion of injured children treated at pediatric trauma centers (TCs), and to provide clarity to the presumed benefit of pediatric TC verification by comparing injury mortality across hospital types.

Methods We performed a population-based cohort study using the 2006 Healthcare Cost and Utilization Project Kids Inpatient Database combined with national TC inventories. We included pediatric discharges (≤16 y) with the International Classification of Diseases, Ninth Revision code(s) for injury. Descriptive analyses were performed evaluating proportions of injured children cared for by TC level. Multivariable logistic regression models were used to estimate differences in in-hospital mortality by TC type (among level-1 TCs only). Analyses were survey-weighted using Healthcare Cost and Utilization Project sampling weights.

Results Of 153,380 injured children, 22.3% were admitted to pediatric TCs, 45.2% to general TCs, and 32.6% to non-TCs. Overall mortality was 0.9%. Among level-1 TCs, raw mortality was 1.0% pediatric TC, 1.4% dual TC, and 2.1% general TC. In adjusted analyses, treatment at level-1 pediatric TCs was associated with a significant mortality decrease compared to level-1 general TCs (adjusted odds ratio, 0.6; 95% confidence intervals, 0.4–0.9).

Conclusions Our results provide the first national evidence that treatment at verified pediatric TCs may improve outcomes, supporting a survival benefit with pediatric trauma verification. Given lack of similar survival advantage found for level-1 dual TCs (both general/pediatric verified), we highlight the need for further investigation to understand factors responsible for the survival advantage at pediatric-only TCs, refine pediatric accreditation guidelines, and disseminate best practices.

From the *Division of Emergency Medicine, Department of Pediatrics, and

Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia;

Department of Biostatistics and Epidemiology, University of Pennsylvania;

§Department of Surgery, Children's Hospital of Philadelphia;

Department of Emergency Medicine, and

Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

Disclosure: Dr Carr spends a portion of his time as the Director of the Emergency Care Coordination Center in the US Department of Health and Human Services. The views expressed here are not necessarily representative of the US Government. The other authors declare no conflict of interest.

Reprints: Sage Myers, MD, MSCE, Children's Hospital of Philadelphia; 3501 Civic Center Blvd; 9th floor, EM Offices, Philadelphia, PA 19104 (e-mail: myerss@email.chop.edu).

This project was funded by a grant from the National Institute of Child Health & Human Development (1R03HD061523-01), the Ruth L. Kirschstein National Research Service Award (F32HS018604-01) from the Agency for Healthcare Research and Quality, and the American Academy of Pediatrics' Ken Graff Young Investigators Grant. Dr Carr was funded by a career development award from the Agency for Healthcare Research & Quality (K08HS017960). Dr Myers was funded by a career development award from the National Cancer Institute (KM1CA156715). Dr Branas was funded by the Centers for Disease Control (R01CE001615).

This work was presented at the Pediatric Academic Societies' Annual Meeting 2011, Denver, CO.

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