Differences in survival outcome for severely injured paediatric trauma by type of trauma centre.
OBJECTIVE
Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured children over treatment at adult trauma centres (ATCs) remains inconclusive. This study examines the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients in New South Wales, Australia.


METHODS
A retrospective examination of paediatric patient characteristics (aged ≤15 years), treatment and injury outcome was conducted using data from the New South Wales Trauma Registry for 2009-2014. Logistic regression was used to examine the association of in-hospital mortality and type of trauma centre.


RESULTS
There were 1230 children who were severely injured (i.e. Injury Severity Score; ISS > 12) and 81.0% received definitive care at a PTC. Two-thirds were male, 37.8% were aged 11-15 years and falls represented 32.0% of the injuries. Almost half (48.9%) the injured children had an ISS between 16 and 24, 31.9% between 25 and 39 and 3.8% an ISS between 40 and 75. The mean and median hospital length of stay was 17.5 and 5 days, respectively. Fifty percent of children that received definitive care at a PTC were admitted to an ICU compared to 23.9% at a Level 1 ATC. There were 119 (9.7%) in-hospital deaths. Children aged ≤15 years who were treated at a Level 1 ATC had 6.1 times higher odds of not surviving their injuries than if treated at a PTC.


CONCLUSIONS
Children who received definitive care at a PTC had a survival advantage compared to those treated at a Level 1 ATC. Prospectively examining the processes of care for severely injured children may assist in identification of quality and system changes required to ensure optimal trauma care within the health-care system.
Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Rebecca J
RJ
Mitchell
Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia.
Kate
K
Curtis
Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Luke
L
Testa
Douglas Cohen Department of Paediatric Surgery and Centre for Trauma Care, Prevention, Education and Research, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Andrew Ja
AJ
Holland
Douglas Cohen Department of Paediatric Surgery and Centre for Trauma Care, Prevention, Education and Research, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Soundappan
S
Sv Soundappan
Sydney Children's Hospital, Sydney, New South Wales, Australia.
Sarah
S
Adams
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000639:trends; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000145:classification* / Q000401:mortality*
injury severity; paediatric; trauma centre; trauma outcome