Trends in Inpatient Pediatric Trauma Care in New England

Abstract

The annual number of childhood injury admissions to New England hospitals decreased by more than half from 1991 through 2000. This study was undertaken to determine whether this decrease was caused by decreased injury incidence or changes in the diagnosis and/or management of childhood injury. Patients younger than 16 years of age with an injury diagnosis code were extracted from the New England Pediatric Trauma Database and an Injury Severity Score and hospital-specific variables were assigned. U.S. Census Bureau age-specific population estimates were used to generate population-based data. Admission rates were analyzed by organ system injured and injury severity category. Acute care length of stay and hospital charges were analyzed. Femur fracture admission rate was used to determine the baseline rate of childhood injury admission, and rates of admission for other injuries were divided by the rate of femur fracture admissions to produce a femur-standardized rate. Variation in this standardized rate was felt to be secondary to changes in the diagnosis and/or management of the injury. The population-based pediatric trauma hospital admission rates decreased 56% during the 10-year study period, from 464 to 208 per 100,000 children per year. Femur fracture admission rates decreased 26% over the same time period. Admission rates for minor injuries decreased by 61% and, when standardized by the rate of injury incidence, as determined by the femur fracture rate, still decreased by 47%. Standardized admission rates for moderate and severe injuries were unchanged. Injury admission rates decreased for most organ systems, except for thoracic and abdominal injuries, which increased 20%. Admission rates for unspecified intracranial, skull, and spine injuries decreased 60%, whereas the admission rate for specified brain injuries was unchanged. The mean, median, and 75th percentile length of stay decreased significantly for moderate and severe injuries. Despite this, median per-patient hospital charges increased each year. Fewer New England children were hospitalized for injury each year during the past decade. Although the overall rate of childhood injury hospitalization declined by half, the majority of the decrease was secondary to changes in the diagnosis and/or management of pediatric injury. Evaluation of the true effectiveness of injury prevention efforts should take this changing diagnosis and management pattern into account.