title: Early impact of American College of Surgeons-verification at a level-1 pediatric trauma center.
abstract: OBJECTIVE
  The purpose of this study was to determine the early impact of American College of Surgeons (ACS)-level-1 verification at an established pediatric trauma center.
  
  
  METHODS
  Following IRB approval, we conducted a retrospective review of all trauma patients treated at a level-1 state-designated pediatric trauma center, comparing 2years before (2009-2010) and 2years after ACS-verification (mid-2012-mid-2014). Statistical significance was defined as p<0.05.
  
  
  RESULTS
  Before verification, 2105 trauma patients were admitted to our institution compared to 2248 patients admitted after ACS-verification. Overall, there were no differences in mean age or injury severity score (ISS). Hospital and pediatric intensive care unit (PICU) length of stay (LOS), ventilator days, and mortality were also unchanged. Through incorporation of clinical pathways, the number of PICU admissions decreased significantly from 17.2% to 13.7%. Morbidity in the form of hospital-acquired conditions (HACS) also decreased following verification, most notably through reduction in pneumonias. Decubitus ulcers and nosocomial infections reached their nadir by 2014. Hospital readmission rates also decreased.
  
  
  CONCLUSIONS
  ACS-verification at a level-1 pediatric trauma center is associated with an immediate benefit to patient outcomes. Enhanced tracking and institutional policy changes resulted in fewer HACS. Further cost-saving and improved outcomes because of ACS-verification may be amplified over time.
authors.affiliation: Division of Pediatric Surgery, St Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA. Electronic address: choip@wustl.edu.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Choi
authors.affiliation: Division of Pediatric Surgery, St Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Hong
authors.affiliation: Division of Pediatric Surgery, St Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Woods
authors.affiliation: Division of Pediatric Surgery, St Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Brad W
authors.initials: BW
authors.lastname: Warner
authors.affiliation: Division of Pediatric Surgery, St Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Keller
mesh_terms: D002568:Certification; D002648:Child; D019091:Critical Pathways / Q000592:standards* / Q000706:statistics & numerical data; D003428:Cross Infection; D005260:Female; D006776:Hospitals, Pediatric / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D008923:Missouri / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000453:epidemiology; D012189:Retrospective Studies; D012955:Societies, Medical / Q000592:standards; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data*
keywords: ACS verification; Pediatric; Registry; Trauma