A National Analysis of Time Adjusted Outcomes for Pediatric Trauma Care

全国儿科创伤护理时间调整结果分析

• 批准号: 7712270
• 负责人: BRENDAN G CARR
• 金额: $ 7.96万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7712270
• 关键词: Accident and Emergency department; Address; Adult; American College of Surgeons; Caring; Cessation of life; Child; Child Care; Child Mortality; Childhood; Classification; Credentialing; Data; Data Set; Data Sources; Databases; Development; Dose; Emergency Care; Emergency Situation; Equipment; Equipment and supply inventories; Future; Hospitals; Injury; Inpatients; Institute of Medicine (U.S.); Intervention; Life; Limb structure; Location; Medical; Mind; Modeling; Operations Research; Operative Surgical Procedures; Outcome; Patients; Pediatric Hospitals; Pharmaceutical Preparations; Policies; Provider; Relative (related person); Reporting; Research Personnel; Resource Allocation; Resources; Role; Sampling; Science; Severities; Shapes; Statistical Methods; System; Testing; Time; Trauma; United States; abstracting; aged; base; care delivery; care systems; compare effectiveness; design; improved; injured; medical attention; mortality; pediatric trauma; public health relevance; trauma centers

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.

描述（由申请人提供）：对儿科创伤护理时间调整结果的国家分析PI：Brendan G。卡尔说：BRENDANCARR摘要：损伤是儿科死亡的主要原因，尽管美国的创伤护理系统非常复杂，但人们对护理设施的类型如何影响儿科创伤的结局知之甚少。受伤的儿童可以在儿科创伤中心、成人创伤中心和非创伤中心医院接受治疗。为了优化受伤患者到适当设施的交付，院前提供者必须权衡与治疗地点相关的生存效益与院前治疗时间增量增加的影响。这项拟议中的研究检查了美国受伤儿童的结果，将分两步进行。本研究的具体目的是：1）确定在儿科创伤中心、成人创伤中心和非创伤中心医院接受治疗的受伤儿童的死亡率是否存在严重度调整差异; 2）确定院前时间与在儿科创伤中心、成人创伤中心和非创伤中心医院接受治疗的儿童的死亡率严重度调整差异之间的关系。这些目标将通过将描述创伤护理类型的变量纳入两个具有全国代表性的样本（全国住院患者样本和儿童住院患者数据库）来实现。然后，我们将比较三种类型的创伤护理医院之间的损伤严重程度调整的结果。为了解决第二个目标，患者水平的院前时间估计将被纳入模型。这些结果将提供与儿科创伤护理水平相关的差异生存率的第一个全国代表性分析，并将测试院前时间是否是创伤和其他时间敏感干预措施的既往结局分析中的未测量混杂因素。研究结果对改善资源分配和儿科创伤护理系统的设计具有重要意义。 公共卫生相关性：一项全国性的儿科创伤护理时间调整结果分析。卡尔eRA共同点：布伦丹卡尔项目叙述：拟议的研究审查在美国受伤儿童的结果。研究人员将使用两个具有全国代表性的数据集来比较在儿科创伤中心、成人创伤中心和非创伤中心医院接受治疗的儿童的严重程度调整后的结果。然后，研究人员将确定院前转运时间在创伤护理类型和死亡率之间的关系中的作用。这些分析将为美国儿科创伤系统的进一步发展提供信息。