Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?
OBJECTIVE
The purposes of the study were to compare the survival associated with treatment of seriously injured patients with pediatric trauma in Florida at designated trauma centers (DTCs) with nontrauma center (NCs) acute care hospitals and to evaluate differences in mortality between designated pediatric and nonpediatric trauma centers.


METHODS
Trauma-related inpatient hospital discharge records from 1995 to 2004 were analyzed for children aged from 0 to 19 years. Age, sex, ethnicity, injury mechanism, discharge diagnoses, and severity as defined by the International Classification Injury Severity Score were analyzed, using mortality during hospitalization as the outcome measure. Children with central nervous system, spine, torso, and vascular injuries and burns were evaluated. Instrumental variable analysis was used to control for triage bias, and mortality was compared by probabilistic regression and bivariate probit modeling. Children treated at a DTC were compared with those treated at a nontrauma center. Within the population treated at a DTC, those treated at a DTC with pediatric capability were compared with those treated at a DTC without additional pediatric capability. Models were analyzed for children aged 0 to 19 years and 0 to 15 years.


RESULTS
For the 27,313 patients between ages 0 and 19 years, treatment in DTCs was associated with a 3.15% reduction in the probability of mortality (P < .0001, bivariate probit). The survival advantage for children aged 0 to 15 years was 1.6%, which is not statistically significant. Treatment of 16,607 children in a designated pediatric DTC, as opposed to a nonpediatric DTC, was associated with an additional 4.84% reduction in mortality in the 0- to 19-year age group and 4.5% in the 0 to 15 years group (P < .001, bivariate probit).


CONCLUSIONS
Optimal care of the seriously injured child requires both the extensive and immediate resources of a DTC as well as pediatric-specific specialty support.
Pracht
Etienne E
EE
University of South Florida College of Public Health, Tampa, FL 33601, USA.
Tepas
Joseph J
JJ
Langland-Orban
Barbara
B
Simpson
Lisa
L
Pieper
Pam
P
Flint
Lewis M
LM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003422:Critical Care / Q000592:standards* / Q000639:trends; D004636:Emergency Service, Hospital / Q000592:standards / Q000639:trends; D005260:Female; D005431:Florida; D019538:Health Care Surveys; D049691:History, Medieval; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014193:Trauma Centers / Q000145:classification*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*