Differences in trauma care among pediatric and nonpediatric trauma centers.
To characterize pediatric trauma care, state trauma registry data from all designated trauma centers in Pennsylvania were divided into three categories, that from: (1) pediatric centers, (2) urban nonpediatric centers, (3) and rural nonpediatric centers. From October 1, 1986 through September 30, 1989 (3 years), 4,615 patients less than 15 years old were admitted to 28 trauma centers in Pennsylvania. Nonpediatric centers cared for the majority of children (2,734, 59.2%), but the average number of children treated per nonpediatric institution (105.1 per year) was far fewer than the average treated in the pediatric centers (940.5). Pediatric trauma centers in the state treated a younger population (6.4 +/- 4.2 years, mean +/- SD) compared with urban and rural nonpediatric centers (8.4 +/- 4.2 and 8.1 +/- 4.3 years, respectively; P less than .05). Pediatric centers received proportionately more children by transfer (56.2%), victims of falls (34.6%), pedestrian injuries (16.8%), and head and neck injuries (41.8%, all P less than .05). Nonpediatric centers received children directly from the scene of injury more frequently than transferred from other hospitals. The male:female sex ratio in urban nonpediatric centers was significantly higher (70.1%, P less than .05) than in the other two groups. Rural nonpediatric centers cared for a higher proportion of motor vehicle passengers (28.5%) and patients classified as "other" in the state registry, a category to which bicycle injuries are assigned (28.2%, P less than .05). Mortality was highest in rural nonpediatric centers (6.2%). The death rate in pediatric centers and urban nonpediatric centers were similar (4.1%) and significantly lower (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
Nakayama
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Department of Pediatric Surgery, Children's Hospital of Pittsburgh, PA 15213.
Copes
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Sacco
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D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000592:standards / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D015996:Survival Rate; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy