Pediatric trauma center criteria: an outcomes analysis.
OBJECTIVE
Trauma centers (TC) are certified based on widely accepted criteria. These specific criteria rarely are scrutinized individually. The purpose of this study was to analyze the individual components of a pediatric trauma center for their effect on outcome.


METHODS
Members of the National Pediatric Trauma Registry were queried about the following: (1) separate pediatric emergency department (ED), (2) pediatric intensive care unit (PICU), (3) pediatric intensivist as PICU director, (4) pediatric surgeon as TC director, (5) in-house attending surgeon, (6) in-house pediatric emergency physician, (7) 24-hour operating room, (8) 24-hour computed tomography (CT) scan. Outcomes analyzed included mortality, length of stay, time in ED, days in PICU, and disability. Victims were stratified based on age (<7 or > or = 7 years) and severity of injury (ISS < or = 16, 17-35, > or = 36). Results were compared using Student's t test and chi2 analysis.


RESULTS
A total of 59 of 74 centers responded, 18 were dropped because of low enrollment (mean, 1.6 patients). Questions 3, 4, 6, and 7 were eliminated because of skewed data. An in-house surgeon reduced the amount of time a mildly injured patient (ISS < or = 16) spent in the ED (210 v434 minutes), as did the separate pediatric ED (333 v592 minutes) and pediatric emergency physicians (344 v 507 minutes) in younger patients (> or = 7 years). An in-house surgeon reduced the morality rate in older (> or = 7) severely injured (ISS > or = 36) patients (46.7% v 56.8%; P < .05 for all). No other differences were significant.


CONCLUSIONS
In-house personnel improved efficiency for the less severely injured, and an in-house attending surgeon reduced mortality in the severely injured older patient. None of the other variables were found to have a significant impact on outcome.
Doolin
E J
EJ
Department of Surgery, Robert Wood Johnson Medical School, Camden, NJ, USA.
Browne
A M
AM
DiScala
C
C
D002648:Child; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000592:standards / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010372:Pediatrics; D014193:Trauma Centers / Q000458:organization & administration / Q000592:standards*; D014481:United States / Q000453:epidemiology