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

Rebecca J. Mitchell, Kate Curtis, Luke Testa, Andrew J A Holland, Soundappan SV Soundappan, Sarah Adams

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aim: Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured children over treatment at adult trauma centres (ATCs) remains inconclusive. This study examines the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients in New South Wales, Australia.

Methods: A retrospective examination of paediatric patient characteristics (aged ≤15years), treatment and injury outcome was conducted using data from the New South Wales Trauma Registry for 2009-2014. Logistic regression was used to examine the association of in-hospital mortality and type of trauma centre.

Results: There were 1230 children who were severely injured (i.e. Injury Severity Score; ISS>12) and 81.0% received definitive care at a PTC. Two-thirds were male, 37.8% were aged 11-15 years and falls represented 32.0% of the injuries. Almost half (48.9%) the injured children had an ISS between 16 and 24, 31.9% between 25 and 39 and 3.8% an ISS between 40 and 75. The mean and median hospital length of stay was 17.5 and 5days, respectively. Fifty percent of children that received definitive care at a PTC were admitted to an ICU compared to 23.9% at a Level 1 ATC. There were 119 (9.7%) in-hospital deaths. Children aged ≤15years who were treated at a Level 1 ATC had 6.1 times higher odds of not surviving their injuries than if treated at a PTC.

Conclusion: Children who received definitive care at a PTC had a survival advantage compared to those treated at a Level 1 ATC. Prospectively examining the processes of care for severely injured children may assist in identification of quality and system changes required to ensure optimal trauma care within the health-care system.

LanguageEnglish
Pages808-813
Number of pages6
JournalJournal of paediatrics and child health
Volume53
Issue number8
Early online date24 Mar 2017
DOIs
Publication statusPublished - Aug 2017

Fingerprint

Trauma Centers
Pediatrics
Survival
Wounds and Injuries
New South Wales
Hospital Mortality
Length of Stay
South Australia
Injury Severity Score
Registries
Logistic Models
Delivery of Health Care

Keywords

  • injury severity
  • paediatric
  • trauma centre
  • trauma outcome

Cite this

Mitchell, Rebecca J. ; Curtis, Kate ; Testa, Luke ; Holland, Andrew J A ; Soundappan, Soundappan SV ; Adams, Sarah. / Differences in survival outcome for severely injured paediatric trauma by type of trauma centre. In: Journal of paediatrics and child health. 2017 ; Vol. 53, No. 8. pp. 808-813.
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abstract = "Aim: Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured children over treatment at adult trauma centres (ATCs) remains inconclusive. This study examines the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients in New South Wales, Australia. Methods: A retrospective examination of paediatric patient characteristics (aged ≤15years), treatment and injury outcome was conducted using data from the New South Wales Trauma Registry for 2009-2014. Logistic regression was used to examine the association of in-hospital mortality and type of trauma centre. Results: There were 1230 children who were severely injured (i.e. Injury Severity Score; ISS>12) and 81.0{\%} received definitive care at a PTC. Two-thirds were male, 37.8{\%} were aged 11-15 years and falls represented 32.0{\%} of the injuries. Almost half (48.9{\%}) the injured children had an ISS between 16 and 24, 31.9{\%} between 25 and 39 and 3.8{\%} an ISS between 40 and 75. The mean and median hospital length of stay was 17.5 and 5days, respectively. Fifty percent of children that received definitive care at a PTC were admitted to an ICU compared to 23.9{\%} at a Level 1 ATC. There were 119 (9.7{\%}) in-hospital deaths. Children aged ≤15years who were treated at a Level 1 ATC had 6.1 times higher odds of not surviving their injuries than if treated at a PTC. Conclusion: Children who received definitive care at a PTC had a survival advantage compared to those treated at a Level 1 ATC. Prospectively examining the processes of care for severely injured children may assist in identification of quality and system changes required to ensure optimal trauma care within the health-care system.",
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Differences in survival outcome for severely injured paediatric trauma by type of trauma centre. / Mitchell, Rebecca J.; Curtis, Kate; Testa, Luke; Holland, Andrew J A; Soundappan, Soundappan SV; Adams, Sarah.

In: Journal of paediatrics and child health, Vol. 53, No. 8, 08.2017, p. 808-813.

Research output: Contribution to journalArticleResearchpeer-review

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