title: Pediatric trauma center criteria: an outcomes analysis.
abstract: 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.
authors.affiliation: Department of Surgery, Robert Wood Johnson Medical School, Camden, NJ, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Doolin
authors.forename: A M
authors.initials: AM
authors.lastname: Browne
authors.forename: C
authors.initials: C
authors.lastname: DiScala
mesh_terms: 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