A National Analysis of Time Adjusted Outcomes for Pediatric Trauma Care

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DESCRIPTION (provided by applicant): A national analysis of time adjusted outcomes for pediatric trauma care PI: Brendan G. Carr eRA COMMONS: BRENDANCARR Abstract: Injury is a leading cause of pediatric death and despite the sophistication of the trauma care system in the United States, little is known about how the type of care facility impacts outcomes for pediatric trauma. Injured children may be treated at pediatric trauma centers, adult trauma centers, and non-trauma center hospitals. To optimize the delivery of injured patients to the appropriate facility, prehospital providers must weigh the survival benefit associated with the place of treatment with the effects of the incremental increase in prehospital time to treatment. The proposed study examines outcomes for injured children in the United States and will be performed in two steps. The specific aims of the study are 1) to determine whether severity- adjusted differences in mortality exist for injured children treated at pediatric trauma centers, adult trauma centers, and non-trauma center hospitals, and 2) to determine how prehospital time is related to severity- adjusted differences in mortality for children treated at pediatric trauma centers, adult trauma centers, and non- trauma center hospitals. These aims will be accomplished by including a variable describing type of trauma care into two nationally representative samples, the Nationwide Inpatient Sample and the Kids Inpatient Database. We will then compare injury severity adjusted outcomes among the three types of trauma care hospitals. To address the second aim, patient level prehospital time estimates will be incorporated into the model. These results will provide the first nationally representative analysis of differential survival associated with level of pediatric trauma care and will test whether prehospital time has been an unmeasured confounder in previous outcomes analyses for trauma and other time sensitive interventions. The results have implications for improved resource distribution and the design of the pediatric trauma care system. PUBLIC HEALTH RELEVANCE: A national analysis of time adjusted outcomes for pediatric trauma care PI: Brendan G. Carr eRA COMMONS: BRENDANCARR Project Narrative: The proposed study examines outcomes for injured children in the United States. The investigators will use two nationally representative datasets to compare severity adjusted outcomes for children treated at pediatric trauma centers, adult trauma centers, and non-trauma center hospitals. The investigators will then determine the role of prehospital transport time in the relationship between type of trauma care and mortality. These analyses will inform the further development of the pediatric trauma system in the US.