Efficacy of pediatric trauma care: results of a population-based study.
To determine concordance between regional outcome and national norms with respect to pediatric injury diagnosis, severity, and mortality in a state lacking a well-organized trauma system, we compared summary data from all pediatric trauma-related hospital discharge abstracts compiled by the [New York State Department of Health] Statewide Planning and Research Cooperative [Mandatory Hospital Reporting] System (SPARCS), with comparable data from pediatric trauma centers participating in the National Pediatric Trauma Registry (NPTR), for similar epochs in the late 1980s. Analysis was based on 14,234 cases from SPARCS and 17,098 cases from NPTR. Data were grouped by principal anatomic diagnosis (ICD-9-CM N-code) and injury severity score (ISS), for each of which incidence and mortality were calculated, both individually and collectively, then compared item by item for sources of variance. Overall, the two data sets showed the expected discordance, with NPTR being skewed toward more complex and severe injury. However, when analyzed cell by cell, a striking degree of concordance emerged in both incidence and mortality for injuries of comparable severity in all but a few selected subsets. Isolated skeletal injuries were treated less frequently in pediatric trauma centers, and combined system injuries to the skeleton, brain, and internal organs were treated more frequently in pediatric trauma centers. However, while the fatality rates were similar between SPARCS and NPTR for most diagnoses, given comparable ISS, survival was some ten times greater in pediatric trauma centers for patients with either brain or internal injuries--the leading causes of pediatric injury mortality--and for skeletal injuries, when the injuries sustained were of moderately great severity.(ABSTRACT TRUNCATED AT 250 WORDS)
Cooper
A
A
Division of Pediatric Surgery, Harlem Hospital Center, College of Physicians & Surgeons of Columbia University, New York, NY 10037.
Barlow
B
B
DiScala
C
C
String
D
D
Ray
K
K
Mottley
L
L
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D009518:New York / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012041:Regional Medical Programs; D012042:Registries; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology*