"Because of their unique physiology, children have particular needs and present challenges to predominantly adult-oriented trauma care delivery systems. There appears to be substantial room for improvement in current pediatric trauma triage systems, and this study suggests that we can save more children's lives," according to lead researcher John C. Densmore, M.D., a resident in the department of surgery at the Medical College.
Using the 2000 Kids' Inpatient Database (KID), an administrative database of the Healthcare Cost and Utilization Project containing more than 2.5 million inpatient discharge records from 27 states, the researchers analyzed nearly 80,000 pediatric trauma cases. First, they found that nearly 90 percent of injured children were treated at adult hospitals or in children's units at adult hospitals. They also found that the 10.7 percent who were treated at children's hospitals had significantly lower mortality rates, lengths of stay and hospital bills.
- Mortality rates were lowest (0.9 percent) in children's hospitals, somewhat worse (1.4 percent) in adult hospitals and highest (2.4 percent) in children's units within adult hospitals
- Lengths of stay greater than the 90th percentile occurred least often at children's hospitals (8.9 percent), somewhat more often in adult hospitals (9.7 percent) and most often in children's units (17.2 percent).
- Hospital charges above $15,000 were more likely in a children's unit (32.4 percent) than in an adult hospital (22.2 percent) or children's hospital (20.2 percent).
In 2002, the most recent year for which data are available, there were 18,953 injury-related deaths among children aged one to 20 years. The study's data indicate that the majority of the youngest and most severely injured children receive care in hospitals with poorer outcomes.
"The geographic disparity and limited number of pediatric surgeons, specialists, and children's hospitals have been cited as the reason for problems in current pediatric trauma care. We hope this study helps people understand the need for pediatric-specific trauma care throughout the United States," says Keith T. Oldham, M.D., professor and chief of surgery and co-author of the study.
Other authors include Karen S. Guice, M.D., clinical professor of pediatrics surgery, and by Hyun J. Limb, M.D., assistant professor in the division of biostatistics in the Health Policy Institute, at the Medical College.
The study was supported in part by the U.S. Department of Health and Human Services and by the American Pediatric Surgical Association Outcomes Center.
Editor's Note:
Children's Study Findings Similar to Recent Adult Study
The Children's study findings echo the conclusion of a similar study of adults comparing trauma centers and non-trauma centers for which Medical College of Wisconsin trauma surgeon,
John A. Weigelt, M.D., served as a consultant. Dr. Weigelt is professor of surgery at the Medical College and chief of the division of trauma and critical care surgery at the Medical College and Froedtert Hospital. "
"A National Evaluation of the Effect of Trauma Center Care on Mortality" was conducted by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of Washington School of Medicine and published in the January 26, 2006, edition of The New England Journal of Medicine.
This study, which included trauma centers and hospitals in Milwaukee, Waukesha, Madison and Racine, is among the first to provide strong data about the effectiveness of specialized trauma care facilities for adults. It indicates that care at a trauma center lowers by 25 percent the risk of death for injured patients compared to treatment received at non-trauma centers.
The Medical College and Children's Research Institute are hoping to replicate this study in children.
Journal
Journal of Pediatric Surgery