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Christopher S. Hollenbeak, PhD1, Jennifer Findeis-Hosey, BS2, Robert E. Cilley, MD3, Stanley J. Kurek, DO4, Andreas Meier, MD3, and Peter W. Dillon, MD, MS3. (1) Surgery and Health Evaluation Sciences, Penn State College of Medicine, 500 University Drive, H113, Hershey, PA 17033, (2) Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, 717-531-5890, jfindeis@psu.edu, (3) Pediatric Surgery, Penn State College of Medicine, 500 University Drive, H113, Hershey, PA 17033, (4) Medicine, Lehigh Valley Hospital, 1200 S Cedar Crest Blvd, Allentown, PA 18103
Purpose. To model formal guidelines for transferring pediatric
patients between trauma centers and predict potential reductions in overall
mortality in a statewide system. Methods. Using data from the
Pennsylvania Trauma Outcome Study (PTOS), we studied 24,172 pediatric trauma
patients admitted to registered trauma centers in Pennsylvania between 1996 and
2002 and modeled the mortality that could be expected under hypothetical
guidelines that would have transferred patients to a pediatric trauma
center. Results. Mortality for
pediatric patients was 3.0%, 8.2% and 4.4% at pediatric, level I and level II
trauma centers, respectively. Predicted
mortality would have remained at 4.0% if all patients age <1 had been
treated at a pediatric trauma center.
However, the model predicted a drop in overall mortality from 4.0% to
3.8% if patients age <1 or with a penetrating injury had been
transferred. A further drop from 968
deaths to 876 deaths, or a further drop in overall mortality to 3.6%, was
predicted had patients with an injury severity score > 14 been treated at a
pediatric trauma center. Conclusions. Guidelines mandating the
transfer to a pediatric trauma center of pediatric trauma patients less than 1
year of age, with penetrating injuries, and with ISS scores >14 would have
saved the lives of 92 children in Pennsylvania.
|
Deaths (Rate) |
Predicted Deaths |
||
Age<1 |
Age<1 OR Penetrating Injury |
Age<1 OR Penetrating Injury OR ISS>14 |
||
Pediatric |
463 (3.0%) |
471 (3.0%) |
579 (3.5%) |
821 (4.3%) |
Level I |
248 (8.2%) |
246 (8.2%) |
115 (5.2%) |
26 (1.8%) |
Level II |
257 (4.4%) |
254 (4.4%) |
222 (4.1%) |
29 (0.8%) |
All Centers |
968 (4.0%) |
971 (4.0%) |
916 (3.8%) |
876 (3.6%) |
Learning Objectives: At the end of this presentation, participants will
Keywords: Injuries, Child Health
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.