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

描述(申请人提供)：创伤性损伤是对我国儿童的重大威胁，其死亡率比所有其他死因的总和还要高。美国外科医师学会创伤委员会表示，受伤儿童有特殊需要，“最好是在儿童医院的环境中提供，并表现出对创伤护理的承诺。”然而，只有一小部分急性护理医院的特征是创伤中心(TC)，更少的是儿科创伤中心(PTC)。与PTC相对稀缺相比，受伤儿童的数量很大，这意味着受伤儿童将在各种医院环境中得到护理。包括PTC在内的大型技术中心通常位于人口密度较高的城市环境中。这造成了健康差距，使农村环境中的儿童处于不利地位，更容易受到严重创伤的不良后果的影响。在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之前，我们不能完全了解各州、地区或国家的儿科创伤的规模和范围。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，并且不一致地报告创伤相关数据，因此在受伤儿童的数量、治疗和结果方面，对这种健康差距的了解存在显著差距。拟议的项目通过分析俄亥俄州创伤登记处的数据迈出了关键的一步，以弥补目前研究中的空白。俄亥俄州创伤登记处按照法律的要求收集了大约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，总共19,187名儿科患者将被分析，以评估相关协变量的住院死亡率、住院时间、手术和并发症。俄亥俄州从现场转移到NTC的患者将与那些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的运输地点(通过EMS或自运)提供关于全州儿童伤害率的有价值的信息。重要的是，2010年俄亥俄州创伤登记中58%的儿科创伤患者是从医院急诊科转到另一家医院的。转院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，需要更长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，并包括一个描述受伤后时间的计算变量。将生成受伤负担、资源和访问权限的地图。我们将估计从受伤到入院到最终护理点之间的距离和所经过的时间，以表征乡村和儿科创伤治疗之间的关系。在项目结束时，我们希望对儿科创伤的严重性和健康差距有更彻底的了解，特别是在农村地区。将生成受伤负担、资源和访问权限的地图。分析结果将反映全州范围内儿童在哪里受伤，他们在哪里首次接受护理，以及需要设施间运输的患者的特征。这项研究将为全州范围内儿童农村健康差距的严重程度提供一个视角，并为未来深入的、前瞻性的全国性研究提供信息。

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.