Pediatric trauma center criteria: An outcomes analysis

Background/Purpose:Trauma centers (TC) are certified based on widely accept ed criteria. These specific criteria rarely are scrutinized individually. T he purpose of this study was to analyze the individual components of a pedi atric trauma center for their effect on outcome. Methods: Members of the National Pediatric Trauma Registry were queried abo ut the following: (1) separate pediatric emergency department (ED), (2) ped iatric intensive care unit (PICU), (3) pediatric intensivist as PICU direct or, (4) pediatric surgeon as TC director, (5) in-house attending surgeon, ( 6) in-house pediatric emergency physician, (7) 24-hour operating room, (8) 24-hour computed tomography (CT) scan. Outcomes analyzed included mortality , length of stay, time in ED, days in PICU, and disability. Victims were st ratified based on age (<7 or greater than or equal to 7 years) and severity of injury (ISS less than or equal to 16, 17-35, greater than or equal to 3 6). Results were compared using Student's t test and chi(2) analysis. Results: A total of 59 of 74 centers responded, 18 were dropped because of low enrollment (mean, 1.6 patients). Questions 3, 4, 6, and 7 were eliminat ed because of skewed data. An in-house surgeon reduced the amount of time a mildly injured patient (ISS less than or equal to 16) spent in the ED (210 v 434 minutes), as did the separate pediatric ED (333 v 592 minutes) and p ediatric emergency physicians (344 v 507 minutes) in younger patients (grea ter than or equal to 7 years). An in-house surgeon reduced the morality rat e in older (greater than or equal to 7) severely injured (ISS greater than or equal to 36) patients (46.7% v 56.8%; P <.05 for all). No other differen ces were significant. Conclusions: In-house personnel improved efficiency for the less severely i njured, and an in-house attending surgeon reduced mortality in the severely injured older patient. None of the other variables were found to have a si gnificant impact on outcome. Copyright (C) 1999 by W.B. Saunders Company.