Impact of pediatric trauma centers on mortality in a statewide system

This study reviewed 1993 to 1997 Pennsylvania Trauma Outcome Study register data in a retrospective analysis of injured children ages 0 to 16. These children were treated in Pennsylvania Trauma Systems Foundation accredited trauma centers PTC (pediatric trauma center), ATC AQ (adult trauma center with added qualification to treat children), ATC I (Level I adult trauma center), and ATC II (Level II adult trauma center). Mortality was the outcome measure and injury severity was measured by ISS, GCS, and RTS. Thirty-nine percent of the pediatric patients included in this study were treated at PTC. These patients were significantly younger than those treated at all ATC. The mean age at the PTC was 7.05 while the mean age at ATC was between 9.63 and 12.73. As patients moved toward adolescence they were more likely to be treated at an ATC. The percentage of blunt injuries ranged between 89% and 93% for all centers. However, the ATC I treated more penetrating injuries than the PTC. ISS and RTS were similar for all centers. Severe head injuries (GCS 3-8) accounted for 16.7% to 25.2% of head injured patients in all centers. The PTC treated the greatest total number of severe head injuries. The PTC had the lowest overall mortality rate. The ATC AQ had a higher mortality rate than the PTC but the study concluded this was not statistically significant. In contrast, the ATC I and the ATC II did have significantly higher mortality rates than the PTC. The outcomes in children with severe head injuries treated at PTC were better than those treated in other centers. Treatment of head injuries was more aggressive at the PTC as more advanced non-operative procedures were used. This improved outcome may also be a reason for the better outcomes of renal and splenic injuries in PTC treated patients. Head injury contributes to childhood mortality in blunt injuries. The PTC was more likely to treat liver and spleen injuries non-operatively than other centers.