title: Factors Associated with Time to Arrival at a Regional Pediatric Trauma Center.
abstract: OBJECTIVE
  The goal of this study was to test the hypothesis that the prehospital time between injury and arrival at a trauma center for critically injured children is associated with patient injury severity and mode of transport.
  
  
  METHODS
  Secondary analysis of prospectively collected data on children 0-17 years of age admitted with traumatic injuries to a designated Level I pediatric trauma center from January 1, 2006 through September 30, 2007 was conducted. Multivariate regression methods were used to assess for factors independently associated with prehospital time.
  
  
  RESULTS
  Of 1,175 admissions during the study period, only 355 (30%) had a prehospital time within 60 minutes of injury. Prehospital time within 60 minutes of injury was associated with higher frequency of coma, higher mean injury severity scores (ISS), and greater frequency of admission to the intensive care unit when compared with prehospital time beyond 60 minutes of injury. Children who arrived at the trauma center within 60 minutes versus beyond 60 minutes were 13-fold (odds ratio [OR]: 12.9; 95% Confidence Interval [CI], 7.6-22.0) more likely to be transported via air ambulance than a private vehicle, and had 4.8-fold greater odds (95% CI, 2.2-10.3) of transport via ground ambulance than private vehicle. For each kilometer of distance between the injury zip code and the trauma center, the odds of arrival within 60 minutes versus beyond 60 minutes decreased by 15% (OR: 0.85; 95% CI, 0.79-0.91).
  
  
  CONCLUSIONS
  Field triage and decision making appeared to correlate with severity of patient injury with expeditious transport of the most severely injured children to definitive trauma care. This finding serves as important groundwork that might enable further study into factors that influence triage and overall prehospital care for critically injured children.
authors.affiliation: 1The Department of Pediatrics and Communicable Diseases,University of Michigan Health System,Ann Arbor,Michigan,USA.
authors.forename: Folafoluwa O
authors.initials: FO
authors.lastname: Odetola
authors.affiliation: 2The Department of Pediatrics,University of Utah School of Medicine,Intermountain Injury Control Research Center,Salt Lake City,Utah,USA.
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
authors.affiliation: 2The Department of Pediatrics,University of Utah School of Medicine,Intermountain Injury Control Research Center,Salt Lake City,Utah,USA.
authors.forename: Kristine W
authors.initials: KW
authors.lastname: Hansen
authors.affiliation: 2The Department of Pediatrics,University of Utah School of Medicine,Intermountain Injury Control Research Center,Salt Lake City,Utah,USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D013997:Time Factors; D014187:Transportation of Patients / Q000592:standards*; D014193:Trauma Centers; D015599:Trauma Severity Indices
keywords: ED emergency department; GCS Glasgow Coma Scale; ISS injury severity score; PCH Primary Children’s Hospital; PICU pediatric intensive care unit; hospital charges; hospitalized children; injuries; length of stay; mortality