Differences in trauma care among pediatric and nonpediatric trauma centers

Abstract

To characterize pediatric trauma care, state trauma registry data from all designated trauma centers in Pennsylvania were divided into three categories, that from: (1) pediatric centers, (2) urban nonpediatric centers, (3) and rural nonpediatric centers. From October 1, 1986 through September 30, 1989 (3 years), 4,615 patients less than 15 years old were admitted to 28 trauma centers in Pennsylvania. Nonpediatric centers cared for the majority of children (2,734, 59.2%), but the average number of children treated per nonpediatric institution (105.1 per year) was far fewer than the average treated in the pediatric centers (940.5). Pediatric trauma centers in the state treated a younger population (6.4 ± 4.2 years, mean ± SD) compared with urban and rural nonpediatric centers (8.4 ± 4.2 and 8.1 ± 4.3 years, respectively; P < .05). Pediatric centers received proportionately more children by transfer (56.2%), victims of falls (34.6%), pedestrian injuries (16.8%), and head and neck injuries (41.8%, all P < .05). Nonpediatric centers received children directly from the scene of injury more frequently than transferred from other hospitals. The male:female sex ratio in urban nonpediatric centers was significantly higher (70.1%, P < .05) than in the other two groups. Rural nonpediatric centers cared for a higher proportion of motor vehicle passengers (28.5%) and patients classified as “other” in the state registry, a category to which bicycle injuries are assigned (28.2%, P < .05). Mortality was highest in rural nonpediatric centers (6.2%). The death rate in pediatric centers and urban nonpediatric centers were similar (4.1%) and significantly lower ( P < .05). Mortality from pedestrian injuries was higher in rural centers (15.1%); other injury mechanisms exhibited no regional differences in mortality. Using TRISS, z for rural centers (1.123) failed to reach statistical significance, whereas z for pediatric and urban nonpediatric centers reached significance (3.896 and 3.335, respectively). Using the probability of survival (P(s)) generated by TRISS analysis, no significant differences in survival were noted among the three groups of trauma centers when P(s) was stratified, although survival was slightly higher in pediatric centers for P(s) ≥.3 and <.6. Important regional differences in pediatric trauma care exist, specifically major differences in patient age, injury, and referral source. Rural trauma centers have a higher pediatric mortality than urban centers, a possible result of differences in access to prehospital care.