The effects of regionalization of pediatric trauma care in the Netherlands

Abstract

System changes in pediatric trauma care may reduce childhood injury mortality. The Dutch system of trauma care has been regionalized in 1999/2000. We evaluated changes in referral behavior and in-hospital mortality before and after regionalization of trauma care in the Netherlands. A surveillance-based before-after study was performed on all children aged up to 18 years that were discharged from one of the hospitals of the trauma care region "Central Netherlands" between 1996 and 1998 and between 2001 and 2006. The in-hospital mortality rate and referral behavior was compared before (1996-1998) and after (2001-2006) regionalization of trauma care in the Netherlands. A total of 21,585 children were included, with a mean (SD) age of 9.6 (5.5) years and a mean (SD) Injury Severity Score (ISS) of 4.3 (4.4). After regionalization, the mean ISS was lower (p = 0.000), and the mean length of stay was lower (p = 0.000). The in-hospital mortality rate was significantly lower for the adolescent group (age, 13-18 years; n = 7,846; standardized mortality ratio, 0.64; 95% confidence interval, 0.34-0.93) after correction for the ISS. No changes were found for the younger children (age, 0-12 years; n = 13,739). No significant differences were found in referral behavior for both age categories. Regionalization of trauma care in the Netherlands reduced the in-hospital mortality rates for adolescents in the last decade. However, this reduction was not caused by a change in referral behavior. Therapeutic study, level IV.