339 Does Shock Index, Pediatric Age-Adjusted Help Predict Mortality by Trauma Center Type?

Abstract

Pediatric trauma patients can be seen at adult trauma centers (ATC), mixed pediatric and adult trauma centers (MTC), or pediatric trauma centers (PTC). Shock index, pediatric age-adjusted (SIPA) can be used to prospectively identify severely injured children. This study characterized the differences in mortality and hospital length of stay (LOS) amongst pediatric trauma patients with elevated SIPA at different trauma centers types. Pediatric patients (1-14 years) were queried from the 2013-2016 National Trauma Data Bank (NTDB). Patients with elevated SIPA (SIPA+) were included for analysis. The primary outcome was mortality. Secondary analyses included hospital length of stay. Unadjusted frequencies and multivariate regression analyses were performed. Out of 190,569 patients, 33,149 were SIPA+. The initial unadjusted odds ratio for mortality showed no significant difference at ATC OR 0.93 (95% CI 0.75, 1.17) or MTC OR 1.11 (95% CI 0.88, 1.39) when compared to PTC. The unadjusted mean hospital length of stay was 3.3 ± 6.97 days at ATC, 3.98 ± 7.17 days at MTC, and 3.64 ± 8.17 days at PTC. After controlling for age, race, sex, payment method, mean ISS, hospital teaching status, and number of hospital beds, amongst SIPA+ patients there was no significant difference in mortality at ATC OR 0.85 (95% CI 0.63, 1.13) and MTC OR 1.07 (95% CI 0.77, 1.47) when compared with PTC. There was also no significant difference in hospital LOS at ATC OR 0.78 (95% CI 0.56, 1.08) and MTC OR 0.93 (95% CI 0.65, 1.35) when compared with PTC. Severely injured children with elevated SIPA have no increased risk of mortality at ATCs or MTCs when compared to PTCs. This finding provides evidence for out-of-hospital systems to determine where severely injured pediatric trauma patients are transported for their initial trauma care.Tabled 1Adjusted Odds Ratios for SIPA+ PatientsType of Trauma CenterMortalityHospital LOSAdult Trauma CenterOR 0.85 (95% CI 0.63, 1.13)OR 0.78 (95% CI 0.56, 1.08)Mixed Trauma CenterOR 1.07 (95% CI 0.77, 1.47)OR 0.93 (95% CI 0.65, 1.35)Pediatric Trauma Center1; Reference1; Reference Open table in a new tab