Casey J Allen1, Laura F Teisch1, Jonathan P Meizoso1, Juliet J Ray1, Carl I Schulman1, Nicholas Namias1, Juan E Sola1, Kenneth G Proctor2. 1. Division of Trauma and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida. 2. Division of Trauma and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: kproctor@miami.edu.
Abstract
BACKGROUND: Despite advances in prehospital emergency medical services (EMS), most advocate "scoop-and-run" over "stay-and-play." However, there are almost no studies in children. We hypothesize that the transportation of mortally injured children is delayed and that the performance of prehospital interventions (PHIs) themselves delay transportation and worsen outcomes in pediatric trauma patients. MATERIALS AND METHODS: A total of 1884 admissions (≤17-y-old) transported via EMS to a level 1 trauma center from January 2000-December 2012 were reviewed. Propensity scores were assigned based on the need for a PHI (intubation and resuscitation). PHI and non-PHI cohorts were matched 1:1 to compare outcomes. Data are expressed as mean ± standard deviation or median (interquartile range). RESULTS: The population was 11 ± 6 y, 70% male, 50% black, 76% blunt injury, injury severity score 13 ± 12, length of stay 3 (7) d, and mortality 3.6%. Incident to EMS arrival was 38 (20) min, EMS on-scene time was 14 (12) min, and overall time of arrival to hospital was 27 (15) min. Patients that were mortally wounded, despite having significantly higher rates of PHI, still had similar transportation times to those who survived. Mostly every measure of injury severity was worse in those who required PHI. When these factors were corrected, EMS on-scene time was 18 (13) versus 14 (13) min (P = 0.551), EMS arrival at the hospital was 31 (16) versus 28 (12) min (P = 0.292), length of stay was 5 (15) versus 4 (12) d (P = 0.368), and mortality was 31.7% versus 28.3% (P = 0.842) for PHI and non-PHI matched cohorts. CONCLUSIONS: PHIs did not delay transportation times or worsen outcomes in pediatric trauma patients. Although mortally injured children more often required PHIs, this did not delay transportation to the trauma center.
BACKGROUND: Despite advances in prehospital emergency medical services (EMS), most advocate "scoop-and-run" over "stay-and-play." However, there are almost no studies in children. We hypothesize that the transportation of mortally injured children is delayed and that the performance of prehospital interventions (PHIs) themselves delay transportation and worsen outcomes in pediatric traumapatients. MATERIALS AND METHODS: A total of 1884 admissions (≤17-y-old) transported via EMS to a level 1 trauma center from January 2000-December 2012 were reviewed. Propensity scores were assigned based on the need for a PHI (intubation and resuscitation). PHI and non-PHI cohorts were matched 1:1 to compare outcomes. Data are expressed as mean ± standard deviation or median (interquartile range). RESULTS: The population was 11 ± 6 y, 70% male, 50% black, 76% blunt injury, injury severity score 13 ± 12, length of stay 3 (7) d, and mortality 3.6%. Incident to EMS arrival was 38 (20) min, EMS on-scene time was 14 (12) min, and overall time of arrival to hospital was 27 (15) min. Patients that were mortally wounded, despite having significantly higher rates of PHI, still had similar transportation times to those who survived. Mostly every measure of injury severity was worse in those who required PHI. When these factors were corrected, EMS on-scene time was 18 (13) versus 14 (13) min (P = 0.551), EMS arrival at the hospital was 31 (16) versus 28 (12) min (P = 0.292), length of stay was 5 (15) versus 4 (12) d (P = 0.368), and mortality was 31.7% versus 28.3% (P = 0.842) for PHI and non-PHI matched cohorts. CONCLUSIONS: PHIs did not delay transportation times or worsen outcomes in pediatric traumapatients. Although mortally injured children more often required PHIs, this did not delay transportation to the trauma center.
Authors: Casey J Allen; Amy E Wagenaar; Davis B Horkan; Daniel J Baldor; William M Hannay; Jun Tashiro; Nicholas Namias; Juan E Sola Journal: Pediatr Surg Int Date: 2016-06-02 Impact factor: 1.827