A National Analysis of Time Adjusted Outcomes for Pediatric Trauma Care

摘要：损伤是儿童死亡的主要原因之一，尽管美国的创伤护理系统非常先进，但人们对护理机构类型如何影响儿童创伤的结果知之甚少。受伤的儿童可以在儿童创伤中心、成人创伤中心和非创伤中心医院接受治疗。为了优化将受伤患者送到适当的设施，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的增量增加的影响。拟议的研究将分两个步骤对美国受伤儿童的结果进行调查。本研究的具体目的是：(1)确定在儿童创伤中心、成人创伤中心和非创伤中心医院治疗的受伤儿童的死亡率是否存在严重调整后的差异；(2)确定院前时间与在儿童创伤中心、成人创伤中心和非创伤中心医院治疗的儿童的死亡率严重调整后的差异之间的关系。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，即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创伤护理医院的损伤严重程度调整结果。为了解决第二个目标，患者院前时间估计将被纳入模型。这些结果将提供与儿童创伤护理水平相关的差异生存的第一个具有全国代表性的分析，并将测试院前时间是否在先前的创伤和其他时间敏感干预措施的结果分析中是一个不可测量的混杂因素。研究结果对改善资源分配和设计儿科创伤护理系统具有重要意义。

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.