BACKGROUND: Trauma is the leading cause of morbidity and mortality in children. During the last few decades, trauma systems have evolved to improve the care of the injured with an ultimate goal of saving lives. As a result, pediatric trauma centers (PTC) have been established to optimize outcomes for injured children. We sought to determine whether injured children treated at PTC or adult trauma centers (ATC) with added qualifications to treat injured children receive better trauma care than those treated at other hospitals or trauma centers. METHODS: We reviewed more than 60 published studies on pediatric trauma outcomes. The studies included registry analysis: single and multihospital experience; abdominal, head and neck, and thoracic trauma; as well as functional outcomes. RESULTS: The data show that most injured children are not treated at PTC due to the geographically limited distribution of such specialized care, lack of pediatric surgeons, and other specialists. These limitations create persistent disparities in outcomes for injured children depending on where they are treated. Some of the larger database analyses suggest lower mortality rate, better outcome for nonoperative treatment of blunt abdominal injuries, and improved overall functional outcome for those children treated at PTC. However, others fail to demonstrate differences for children treated at ATC or ATC with added qualifications. CONCLUSION: Although this analysis does not provide a definitive answer to the question as to which type of trauma center provides better care for injured pediatric patients, it identifies current gaps and disparities in the care of injured children that can be remedied through education and training.
BACKGROUND:Trauma is the leading cause of morbidity and mortality in children. During the last few decades, trauma systems have evolved to improve the care of the injured with an ultimate goal of saving lives. As a result, pediatric trauma centers (PTC) have been established to optimize outcomes for injured children. We sought to determine whether injured children treated at PTC or adult trauma centers (ATC) with added qualifications to treat injured children receive better trauma care than those treated at other hospitals or trauma centers. METHODS: We reviewed more than 60 published studies on pediatric trauma outcomes. The studies included registry analysis: single and multihospital experience; abdominal, head and neck, and thoracic trauma; as well as functional outcomes. RESULTS: The data show that most injured children are not treated at PTC due to the geographically limited distribution of such specialized care, lack of pediatric surgeons, and other specialists. These limitations create persistent disparities in outcomes for injured children depending on where they are treated. Some of the larger database analyses suggest lower mortality rate, better outcome for nonoperative treatment of blunt abdominal injuries, and improved overall functional outcome for those children treated at PTC. However, others fail to demonstrate differences for children treated at ATC or ATC with added qualifications. CONCLUSION: Although this analysis does not provide a definitive answer to the question as to which type of trauma center provides better care for injured pediatric patients, it identifies current gaps and disparities in the care of injured children that can be remedied through education and training.
Authors: Jennifer M Zumsteg; Stephanie K Ennis; Kenneth M Jaffe; Rita Mangione-Smith; Ellen J MacKenzie; Frederick P Rivara Journal: Arch Phys Med Rehabil Date: 2012-01-26 Impact factor: 3.966
Authors: Wanda D Barfield; Steven E Krug; Robert K Kanter; Marianne Gausche-Hill; Mary D Brantley; Sarita Chung; Niranjan Kissoon Journal: Pediatr Crit Care Med Date: 2011-11 Impact factor: 3.624
Authors: Lindsey L Wolf; Ritam Chowdhury; Jefferson Tweed; Lori Vinson; Elena Losina; Adil H Haider; Faisal G Qureshi Journal: J Pediatr Date: 2017-05-25 Impact factor: 4.406
Authors: Gregory P Murphy; Thomas W Gaither; Mohannad A Awad; E Charles Osterberg; Nima Baradaran; Hillary L Copp; Benjamin N Breyer Journal: Curr Urol Rep Date: 2017-03 Impact factor: 3.092
Authors: Leslie A Dervan; Mary A King; Joseph Cuschieri; Frederick P Rivara; Noel S Weiss Journal: J Trauma Acute Care Surg Date: 2015-08 Impact factor: 3.313
Authors: Rachel B Webman; Elizabeth A Carter; Sushil Mittal; Jichaun Wang; Chethan Sathya; Avery B Nathens; Michael L Nance; David Madigan; Randall S Burd Journal: JAMA Pediatr Date: 2016-08-01 Impact factor: 16.193