Injury is the most important public health threat to children in this country. In fact, more childhood deaths can be attributed to trauma than to all other causes combined. However, the care for injured children is quite variable across the country. Injured children can be cared for at trauma centers, which have demonstrated a commitment to trauma and the availability of appropriate personnel and equipment, or they can be cared for at general emergency departments, which may not be fully equipped for trauma, especially for pediatric victims. In fact, recent literature has shown that only half of emergency departments in the country have a majority of the recommended pediatric equipment for emergency care of children and a large number of providers in smaller hospitals lack appropriate training in pediatric resuscitation. This variability in provider and institutional characteristics lead to concern for variability in the care provided to pediatric trauma patients. Past studies on adult trauma have shown improved outcome for trauma victims treated at the highest level trauma centers. However, there are few studies focused on pediatric trauma victims, especially with regard to optimal location of care. In 2006, The Institute of Medicine identified the need for research to inform the integration of children into a national trauma system as an important part of the solution to the national crisis in emergency care for children. Therefore, we propose the first in a series of studies looking at the comparative effectiveness of pediatric trauma care by hospital type. In this study, we will examine differences in mortality, on a national level, for injured children cared for at hospitals with varying levels of trauma designation. We will use the Kids Inpatient Database, administered by the Healthcare Cost and Utilization Project, which is a weighted national sample of all pediatric discharges in the country. Using subjects under 16 years old in the database, we will compare injury severity-adjusted mortality for children admitted to hospitals of different trauma level designations, while adjusting for confounding factors. Statistical analysis will include unvariate and stratified analyses as well as simple and multivariate logistic regression. 1 in every 4 children in the United States is injured each year and injury is the leading cause of death for children. Therefore, improvements in the organization and delivery of care to the injured child should be a national priority.
We aim to produce results which will lay the groundwork for the development of an effective and efficient trauma care system, fully integrating pediatric patients to improve outcomes for injured children.
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| Myers, Sage R; Branas, Charles C; French, Benjamin C et al. (2013) Safety in numbers: are major cities the safest places in the United States? Ann Emerg Med 62:408-418.e3 |
| Carr, Brendan G; Nance, Michael L; Branas, Charles C et al. (2012) Unintentional firearm death across the urban-rural landscape in the United States. J Trauma Acute Care Surg 73:1006-10 |
| Myers, Sage R; Branas, Charles C; Kallan, Michael J et al. (2011) The use of home location to proxy injury location and implications for regionalized trauma system planning. J Trauma 71:1428-34 |
