title: Impact of operative intervention delay on pediatric trauma outcomes.
abstract: BACKGROUND
  Establishing quality indicators is an essential step in improving mortality and disability among pediatric patients with trauma. We hypothesized that timing of craniotomy, intracranial pressure (ICP) monitoring for traumatic brain injury, and abdominal operation for solid organ injury correlates with a reduced risk of death, shorter stay, and reduced risk of requiring assistance at discharge.
  
  
  METHODS
  This was a retrospective cohort study of 99,513 pediatric patients with trauma, using the National Trauma Data Bank.
  
  
  RESULTS
  For patients who had an ICP monitor placed within 4 hours compared with those whose ICP monitor was delayed, there was no difference in mortality; however, there was a shorter stay in the hospital (relative risk [RR], 0.84; 95% confidence interval (CI), 0.72-0.97) and in the intensive care unit (ICU) (RR, 0.76; 95% CI, 0.66-0.86) in those that survived to discharge. Patients who had craniotomy within 4 hours had higher mortality (RR, 1.98; 95% CI, 1.11-3.51) compared with those that were delayed. After excluding those that died, there was a shorter overall stay (RR, 0.69; 95% CI, 0.59-0.81) and ICU stay (RR, 0.69; 95% CI, 0.57-0.83). Similar length of stay results were seen in pediatric patients with solid organ injuries. Excluding those that died, length of stay (RR, 0.58; 95% CI, 0.47-0.73) and ICU stay (RR, 0.52; 95% CI, 0.37-0.74) were shorter.
  
  
  CONCLUSIONS
  Early intervention in those who survive their initial operation is associated with shorter ICU and hospital stay for traumatic brain and solid organ injuries.
  
  
  METHODS
  Therapeutic study, level III.
authors: Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA. ghd@u.washington.edu
authors: Giana H
authors: GH
authors: Davidson
authors: Ronald V
authors: RV
authors: Maier
authors: Saman
authors: S
authors: Arbabi
authors: Adam B
authors: AB
authors: Goldin
authors: Frederick P
authors: FP
authors: Rivara
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D002648:Child; D003399:Craniotomy / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D007902:Length of Stay; D008297:Male; D008991:Monitoring, Physiologic; D016012:Poisson Distribution; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*