Pediatric trauma system models: do systems using adult trauma surgeons exclusively compare favorably with those using pediatric surgeons after initial resuscitation with an adult trauma surgeon?
BACKGROUND
A shortage of pediatric surgeons exists. The purpose of this study was to evaluate pediatric outcomes using pediatric surgeons vs adult trauma surgeons.


METHODS
A review was conducted at 2 level II pediatric trauma centers. Center I provides 24-hour in-house trauma surgeons for resuscitations, with patient hand-off to a pediatric surgery service. Center II provides 24-hour in-house senior surgical resident coverage with an on-call trauma surgeon. Data on demographics, resource utilization, and outcomes were collected.


RESULTS
Center I patients were more severely injured (injury severity score = 8.3 vs 6.2; Glasgow coma scale score = 13.7 vs 14.3). Center I patients were more often admitted to the intensive care unit (52.2% vs 33.5%) and more often mechanically ventilated (12.9% vs 7.7%), with longer hospital length of stay (2.8 vs 2.3 days). However, mortality was not different between Center I and II (3.1% vs 2.4%). By logistic regression analyses, the only variables predictive of mortality were injury severity score and Glasgow coma scale score.


CONCLUSIONS
As it appears that trauma surgeons' outcomes compare favorably with those of pediatric surgeons, utilizing adult trauma surgeons may help alleviate shortages in pediatric surgeon coverage.
Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA.
P J
PJ
Stiles
Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA; Department of Medical Education, Via Christi Hospital Saint Francis, 929 N. Saint Francis St., Room 3082, Wichita, KS, USA.
Stephen D
SD
Helmer
Department of Trauma Services, Via Christi Hospital Saint Francis, 929 N. Saint Francis St., Room 2514, Wichita, KS 67214, USA.
Jeanette G
JG
Ward
Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA.
Jared
J
Reyes
Department of Trauma Services, Wesley Medical Center, 550 N. Hillside, Wichita, KS 67214, USA.
Paul B
PB
Harrison
Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA; Department of Trauma Services, Via Christi Hospital Saint Francis, 929 N. Saint Francis St., Room 2514, Wichita, KS 67214, USA. Electronic address: James.Haan.Research@viachristi.org.
James M
JM
Haan
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007615:Kansas; D007902:Length of Stay / Q000706:statistics & numerical data; D017146:Models, Organizational; D009825:Oklahoma; D010043:Outcome and Process Assessment, Health Care; D010372:Pediatrics / Q000458:organization & administration*; D011237:Predictive Value of Tests; D012151:Resuscitation; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*
Adult trauma surgeons; Outcomes; Pediatric trauma surgeons; Trauma systems