The impact of pediatric trauma centers on the outcome of injured children in Ohio

儿科创伤对俄亥俄州受伤儿童结局的影响

• 批准号: 8443553
• 负责人: Laura D Cassidy
• 金额: $ 8.43万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-15 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8443553
• 关键词: 18 year old; 21 year old; Accident and Emergency department; Acute; Address; Admission activity; Age; American College of Surgeons; Caring; Cause of Death; Cessation of life; Characteristics; Child; Childhood; Clinical Data; Craniocerebral Trauma; Data; Data Analyses; Data Collection; Data Element; Databases; Decision Making; Disadvantaged; Disease; Employee Strikes; Environment; Equipment and supply inventories; Evaluation; Future; Glasgow Coma Scale; Hospital Mortality; Hospitals; Individual; Injury; Inpatients; Investigation; Knowledge; Laws; Left; Length of Stay; Literature; Location; Maps; Methods; Modeling; Morbidity - disease rate; Ohio; Outcome; Patient Transfer; Patients; Pattern; Pediatric Hospitals; Population; Population Density; Registries; Relative (related person); Reporting; Research; Resource Allocation; Resources; Rural; Rural Health; Sampling; Series; Severities; Surface; Survivors; System; Time; Trauma; Travel; Treatment outcome; Triage; United States; Visit; Vulnerable Populations; base; catalyst; cost; health disparity; improved; injured; injury burden; life time cost; mortality; novel; operation; pediatric trauma; point of care; prospective; public health relevance; rural area; social; trauma care; trauma centers

DESCRIPTION (provided by applicant): Traumatic injury is a significant threat to our nation's children, having a higher mortality rate than all other causes of death combined. The American College of Surgeons Committee on Trauma states that injured children have special needs that "may be optimally provided [for] in the environment of a children's hospital with a demonstrated commitment to trauma care." However, only a small proportion of acute care hospitals are characterized as trauma centers (TC), and even fewer are pediatric trauma centers (PTC). The large number of injured children, compared to the relative scarcity of PTCs, dictates that injured children will be cared for in a variety of hospital settings. Large TCs, including PTCs, are generally located in urban settings with a high population density. This creates a health disparity, leaving children in rural settings at a disadvantage and more vulnerable to poor outcomes from severe trauma. We cannot fully understand the magnitude and scope of pediatric trauma by state, region or nationally until we begin to analyze data collected from non-trauma centers as part of a statewide system. Because most injured children are treated in centers that lack trauma center designation and do not consistently, if at all, report trauma-related data, there is a significant gap in knowledge about this health disparity regarding the volume, treatments, and outcomes of injured children. The proposed project takes a critical step to address this current gap in research by analyzing data from the Ohio Trauma Registry, which captures data from approximately 87% of Ohio hospitals, as required by law, including 138 non-trauma centers (NTC). A total of 19,187 pediatric patients, over a 5-year period, will be analyzed to evaluate in-hospital mortality, length of stay, operations and complications by relevant covariates. Patients transferred from scene to an NTC, in the state of Ohio will be compared to those transferred directly from scene to a designated TC. This will provide valuable information about statewide pediatric injury rates, based on population density and where they are initially transported (via EMS or self- transport). Importantly, 58% of the traumatically injured pediatric patients in the Ohio trauma registry in the year 2010 were transferred from a hospital emergency department to another hospital. The outcomes of transferred patients may be confounded, as the patients may be more severely injured and have longer delays to appropriate specialized care. Therefore, we will analyze this group separately and include a calculated variable describing time since injury. Maps of injury burden, resources and access will be generated. We will estimate both distance traveled and time elapsed between injury and admission to the final point of care to characterize the relationship between rurality and treatment of pediatric trauma. At the end of the project, we expect to have a more thorough understanding of the magnitude of pediatric trauma and health disparities, especially in rural areas. Maps of injury burden, resources and access will be generated. The results of the analysis will reflect a statewide representation of where children are injured, where they first receive care and a characterization of patients who require inter-facility transport. This study wil provide a statewide perspective on the magnitude of the pediatric rural health disparity, and inform a future in-depth, prospective national study.

描述（由申请人提供）：创伤伤害对我们国家的儿童构成了重大威胁，其死亡率比所有其他死亡原因总和更高。美国外科医生学院创伤学院指出，受伤儿童有特殊需要，“在儿童医院的环境中可以最佳地提供，并表现出对创伤护理的承诺”。但是，只有一小部分的急诊医院被描述为创伤中心（TC），而小儿创伤中心（PTC）甚至更少。与PTC的相对稀缺相比，大量受伤的儿童决定受伤的儿童将在各种医院环境中得到照顾。包括PTC在内的大型TC通常位于人口密度较高的城市环境中。这会造成健康差异，使儿童处于劣势，并且更容易受到严重创伤的不良后果。我们不能完全了解按国家，地区或全国范围内的小儿创伤的大小和范围，直到我们开始分析作为全州系统的一部分从非创伤中心收集的数据。由于大多数受伤的儿童都受到缺乏创伤中心指定的中心的治疗，并且不一定地报告与创伤相关的数据，因此有关这种健康差异的知识存在很大的差距，这些差异与受伤儿童的数量，治疗和结果有关。拟议的项目通过分析俄亥俄州创伤注册中心的数据采取了关键的一步来解决研究的这一差距，该数据按照法律要求捕获大约87％的俄亥俄州医院的数据，其中包括138个非Trauma Centers（NTC）。在5年期间，总共有19,187名儿科患者通过相关协变量评估住院内死亡率，住院时间，操作和并发症的时间。将从场景转移到NTC的患者将与直接从场景转移到指定的TC的患者进行比较。这将根据人口密度以及最初运输的地方（通过EMS或自运输）提供有关全州儿科损伤率的宝贵信息。重要的是，2010年，俄亥俄州创伤注册表中有58％的创伤受伤的儿科患者从医院急诊室转移到另一家医院。转移患者的结果可能会混淆，因为患者可能会受到严重伤害，并且延迟了适当的专业护理。因此，我们将分别分析该组，并包括一个计算的变量，该变量描述了自受伤以来的时间。将产生伤害负担，资源和访问的地图。我们将估计受伤和入院之间经过的距离和时间的距离，以表征小儿创伤的农村关系与治疗之间的关系。在项目结束时，我们希望对小儿创伤和健康差异的大小有更深入的了解，尤其是在农村地区。将产生伤害负担，资源和访问的地图。分析的结果将反映出儿童受伤的地方的全州代表，他们首先接受了护理以及需要交通际交通的患者的特征。这项研究将对儿科乡村健康差异的大小提供全州范围的观点，并为未来的深入，前瞻性的国家研究提供信息。