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）：创伤性伤害是对我国儿童的重大威胁，其死亡率高于所有其他死亡原因的总和。美国外科医师学会创伤委员会指出，受伤的儿童有特殊需求，“在儿童医院的环境中，有明确的创伤护理承诺，可能会得到最佳的满足。”然而，只有一小部分急症护理医院被定性为创伤中心（TC），更少的是儿科创伤中心（PTC）。受伤儿童人数众多，而ptc相对短缺，这决定了受伤儿童将在各种医院环境中得到照顾。包括ptc在内的大型tc通常位于人口密度高的城市环境中。这造成了健康差距，使农村儿童处于不利地位，更容易受到严重创伤的不良后果的影响。直到我们开始分析从非创伤中心收集的数据，作为全州系统的一部分，我们才能完全了解各州、地区或全国儿童创伤的程度和范围。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，并且没有一致地（如果有的话）报告与创伤相关的数据，因此在关于受伤儿童的数量、治疗和结果的健康差异的知识方面存在重大差距。拟议的项目通过分析俄亥俄州创伤登记处的数据，迈出了解决目前研究差距的关键一步，该登记处根据法律要求收集了大约87%的俄亥俄州医院的数据，其中包括138个非创伤中心（NTC）。在5年的时间里，共分析了19,187名儿科患者，通过相关协变量评估住院死亡率、住院时间、手术和并发症。在俄亥俄州，从现场转移到NTC的患者将与直接从现场转移到指定TC的患者进行比较。这将提供关于全州儿童受伤率的有价值的信息，基于人口密度和他们最初被运送的地方（通过EMS或自运输）。重要的是，2010年俄亥俄州创伤登记处58%的创伤性儿科患者从医院急诊科转到另一家医院。转院患者的结果可能会混淆，因为患者可能受伤更严重，需要更长的时间才能得到适当的专门护理。因此，我们将单独分析这一组，并包括一个计算变量来描述受伤后的时间。将生成伤害负担、资源和获取的地图。我们将估计从受伤到最终护理点之间的路程和时间，以表征乡村性和儿科创伤治疗之间的关系。在项目结束时，我们期望对儿童创伤的严重程度和健康差距有更全面的了解，特别是在农村地区。将生成伤害负担、资源和获取的地图。分析结果将反映出全州范围内儿童受伤地点、他们首先接受治疗的地点以及需要跨设施运输的患者特征。本研究将提供全州范围内农村儿童健康差异程度的视角，并为未来深入的前瞻性全国研究提供信息。