Impact of Pediatric Trauma Centers on Outcomes of Injured Children

儿科创伤中心对受伤儿童结局的影响

• 批准号: 9265781
• 负责人: Scott A Lorch
• 金额: $ 25万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-22 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9265781
• 关键词: Impact; Pediatric; Trauma; Centers; Outcomes

 DESCRIPTION (provided by applicant): Injury is the most significant public health threat to children in the United States: 14 million children less than 15 years of age are injured each year, resulting in 9 million hospital visits, 250,000 hospital admissions, and 50.5 billion dollars in toal costs annually. More children between 1 and 14 years of age die from injury-related causes than all other causes combined. Despite this, a comprehensive and evidence-based approach to pediatric trauma management is lacking. While specialized hospitals for children exist in the US, they represent only a small portion of the overall number of hospitals, and it has been estimated that only 11% of injured children are treated at pediatric hospitals and only 13% at a hospital with some trauma credentialing. The remaining injured children are treated at general acute care hospitals. The impact of this disjointed system is unknown. First, there is conflicting data over the effect of receiving care at a pediatric trauma center compared to a general acute hospital. These conflicting results stem from several features of the pediatric trauma literature. Analyzing the outcomes of pediatric trauma by the location of treatment is inherently biased by illness severity and other unmeasured factors. Pediatric centers are likely to treat the sickest patients, if they are preferentially transported to these centers "at the discretion" of emergency medical services. Available data may not be able to adequately control for these differences. Although several trauma severity scores have been published, these scores may not adequately control for casemix differences between hospitals - especially for pediatric patients. Second, there are no studies to identify the structures and processes of care that improve the outcomes of pediatric trauma. Thus, the goal of this study is to identify the structures and processes of care that optimize outcomes of pediatric trauma patients, by obtaining an unbiased estimate of the relationship between structures, processes of care, and outcomes in pediatric trauma patients from 15 states between 2012 and 2013. Many of the aforementioned methodological flaws can be addressed through a combination of (1) an instrumental variables approach for unmeasured confounders, (2) two-stage modeling for measured confounders, and (3) the first survey of the available structures and processes of care at emergency departments and trauma centers in the United States that treat children. This research falls under the Value portfolio of the Agency for Healthcare Research and Quality research program, as it projects how changes to the pediatric trauma system will affect the quality and value of this system, and the Comparative Effectiveness portfolio, to determine the most effective organization of the pediatric trauma system. Improved understanding of the impact of such service changes will result in more efficient use of health care services and optimize the value of health care dollars spent on treating pediatric injury and trauma.

 伤害是美国儿童面临的最重大的公共卫生威胁：每年有1400万15岁以下的儿童受伤， 每年有900万人次到医院就诊，25万人次入院，总花费达505亿美元。1至14岁的儿童死于与伤害有关的原因的人数超过所有其他原因的总和。尽管如此，一个全面的和循证的方法来儿科创伤管理是缺乏的。虽然美国有专门的儿童医院，但它们只占医院总数的一小部分，据估计，只有11%的受伤儿童在儿科医院接受治疗，只有13%的儿童在有创伤认证的医院接受治疗。其余受伤儿童在综合急症医院接受治疗。这种脱节的系统的影响是未知的。首先，在儿科创伤中心接受治疗的效果与在普通急症医院接受治疗的效果之间存在矛盾。这些相互矛盾的结果源于儿科创伤文献的几个特征。通过治疗的位置来分析儿科创伤的结果本身就受到疾病严重程度和其他不可测量因素的影响。儿科中心很可能治疗病情最严重的病人，如果他们优先运送到这些中心的“酌情”紧急医疗服务。现有数据可能无法充分控制这些差异。虽然已经公布了几个创伤严重度评分，但这些评分可能无法充分控制医院之间的病例组合差异-特别是儿科患者。其次，没有研究来确定改善儿科创伤结局的护理结构和过程。因此，本研究的目标是通过对2012年至2013年15个州的儿科创伤患者的结构、护理过程和结局之间的关系进行无偏估计，确定优化儿科创伤患者结局的护理结构和过程。上述许多方法上的缺陷可以通过以下方法的结合来解决：（1）用于未测量混杂因素的工具变量方法，（2）用于测量混杂因素的两阶段建模，以及（3）对美国急诊科和创伤中心治疗儿童的可用结构和护理过程的首次调查。本研究福尔斯属于医疗保健研究和质量研究计划署的价值组合，因为它预测了儿科创伤系统的变化将如何影响该系统的质量和价值，以及比较有效性组合，以确定儿科创伤系统的最有效组织。更好地了解这种服务变化的影响将导致更有效地利用医疗保健服务，并优化用于治疗儿科损伤和创伤的医疗保健资金的价值。