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

基本信息

批准号：
8701181
负责人：
Laura D Cassidy
金额：
$ 8.19万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-15 至 2016-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8701181
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

项目摘要

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）：创伤性伤害对我国儿童构成重大威胁，其死亡率高于所有其他死亡原因的总和。美国外科医生学会创伤委员会表示，受伤的儿童有特殊需要，“可以在儿童医院的环境中得到最佳的满足，并明确致力于创伤护理。”然而，只有一小部分急症护理医院被称为创伤中心 (TC)，而小儿创伤中心 (PTC) 则更少。与 PTC 相对稀缺相比，受伤儿童数量众多，这决定了受伤儿童将在各种医院环境中得到护理。大型 TC（包括 PTC）通常位于人口密度较高的城市地区。这造成了健康差距，使农村儿童处于不利地位，更容易因严重创伤而导致不良后果。在我们开始分析作为全州系统一部分的非创伤中心收集的数据之前，我们无法完全了解各州、地区或全国儿童创伤的严重程度和范围。由于大多数受伤儿童在缺乏创伤中心指定的中心接受治疗，并且报告创伤相关数据的情况不一致（如果有的话），因此对于受伤儿童的数量、治疗和结果方面的这种健康差异的了解存在很大差距。拟议的项目通过分析俄亥俄州创伤登记处的数据，为解决当前的研究空白迈出了关键的一步，该登记处按照法律要求从约 87% 的俄亥俄州医院收集数据，其中包括 138 个非创伤中心 (NTC)。将在 5 年时间内对总共 19,187 名儿科患者进行分析，以通过相关协变量评估院内死亡率、住院时间、手术和并发症。从俄亥俄州现场转移到 NTC 的患者将与直接从现场转移到指定 TC 的患者进行比较。这将根据人口密度和最初运输地点（通过 EMS 或自助运输）提供有关全州儿童受伤率的宝贵信息。重要的是，2010 年俄亥俄州创伤登记处 58% 的创伤儿科患者从医院急诊科转移到另一家医院。转移患者的结果可能会令人困惑，因为患者可能受到更严重的伤害，并且需要更长的时间才能获得适当的专业护理。因此，我们将单独分析该组，并包括一个描述受伤后时间的计算变量。将生成伤害负担、资源和获取途径的地图。我们将估计受伤和进入最终护理点之间的行驶距离和时间，以描述农村地区与儿科创伤治疗之间的关系。在项目结束时，我们希望能够更全面地了解儿科创伤和健康差异的严重程度，特别是在农村地区。将生成伤害负担、资源和获取途径的地图。分析结果将反映全州范围内儿童受伤地点、他们首先在哪里接受护理以及需要跨设施转运的患者的特征。这项研究将为全州范围内农村儿科健康差距的严重程度提供视角，并为未来深入的前瞻性全国研究提供信息。