TITLE:
Distribution Patterns of Severe Pediatric Trauma: Mandated vs. Non-Mandated Trauma Systems
AUTHORS:
Raouf M. Afifi, Sameh S. Zaytoun
KEYWORDS:
Child Injury; High Risk; Distribution Pattern; Trauma System; Mandated
JOURNAL NAME:
Surgical Science,
Vol.4 No.9,
August
20,
2013
ABSTRACT: Objective: To identify how hospital discharge data could discriminate the distribution patterns of high-risk trauma children in mandated and non-mandated trauma
systems. Methods: Hospital discharge data of pediatric trauma patients 1 - 15 years
of age in Florida (FL), USA—[a mature mandated trauma system
with certified trauma centers (TCs)] and in Indiana (IN), USA—(an immature
non-mandated trauma system) admitted both to trauma center (TC)
and non-TC healthcare facilities were analyzed. The injury severity score (ISS)
measurement was used to verify injury severities. Results: Analysis
showed that the majority of admissions were mild injuries (ISS = 1 - 8), [FL
70%, IN 66%, odds ratio (OR)
1.2, 95% confidence interval (CI) 1.1, 1.3]. Florida trauma children (all severities) generally
receive TC care more frequently than Indiana’s
(OR = 1.8, CI 1.6 - 1.9). Particularly admission to TCs with
severe (ISS ≥ 25) pelvic injury was greater in Florida (OR 3.5, CI 1.6 - 7.4).
Florida, encountered some other severe injury mechanisms (motor vehicle
accidents, falls) more frequently than Indiana (ORs and CI: 2.2, 1.5 - 3.3 and
3.1, 1.1 - 8.7, respectively). Conclusions: Hospital discharge data can demonstrate the expected patient distribution
difference when comparing a mature trauma system with a voluntary evolving
system. The level of maturity of the adopted trauma system often influences
such difference.