Prehospital care and transportation of pediatric trauma patients

Casey J. Allen, Laura F. Teisch, Jonathan P. Meizoso, Juliet J. Ray, Carl I Schulman, Nicholas Namias, Juan E Sola, Kenneth G Proctor

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)240-246
Number of pages7
JournalJournal of Surgical Research
Volume197
Issue number2
DOIs
StatePublished - Aug 1 2015

Fingerprint

Emergency Medical Services
Pediatrics
Wounds and Injuries
Trauma Centers
Length of Stay
Propensity Score
Nonpenetrating Wounds
Injury Severity Score
Mortality
Intubation
Resuscitation
Population

Keywords

  • Adolescents
  • Ambulance
  • Children
  • Emergency medical services

ASJC Scopus subject areas

  • Surgery

Cite this

Prehospital care and transportation of pediatric trauma patients. / Allen, Casey J.; Teisch, Laura F.; Meizoso, Jonathan P.; Ray, Juliet J.; Schulman, Carl I; Namias, Nicholas; Sola, Juan E; Proctor, Kenneth G.

In: Journal of Surgical Research, Vol. 197, No. 2, 01.08.2015, p. 240-246.

Research output: Contribution to journalArticle

Allen, Casey J. ; Teisch, Laura F. ; Meizoso, Jonathan P. ; Ray, Juliet J. ; Schulman, Carl I ; Namias, Nicholas ; Sola, Juan E ; Proctor, Kenneth G. / Prehospital care and transportation of pediatric trauma patients. In: Journal of Surgical Research. 2015 ; Vol. 197, No. 2. pp. 240-246.
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AU - Teisch, Laura F.

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AU - Schulman, Carl I

AU - Namias, Nicholas

AU - Sola, Juan E

AU - Proctor, Kenneth G

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N2 - 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.

AB - 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.

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