Mitchell Rebecca J, Curtis Kate, Testa Luke, Holland Andrew Ja, Sv Soundappan Soundappan, Adams Sarah
Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2017 Aug;53(8):808-813. doi: 10.1111/jpc.13514. Epub 2017 Mar 24.
Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured children over treatment at adult trauma centres (ATCs) remains inconclusive. This study examines the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients in New South Wales, Australia.
A retrospective examination of paediatric patient characteristics (aged ≤15 years), treatment and injury outcome was conducted using data from the New South Wales Trauma Registry for 2009-2014. Logistic regression was used to examine the association of in-hospital mortality and type of trauma centre.
There were 1230 children who were severely injured (i.e. Injury Severity Score; ISS > 12) and 81.0% received definitive care at a PTC. Two-thirds were male, 37.8% were aged 11-15 years and falls represented 32.0% of the injuries. Almost half (48.9%) the injured children had an ISS between 16 and 24, 31.9% between 25 and 39 and 3.8% an ISS between 40 and 75. The mean and median hospital length of stay was 17.5 and 5 days, respectively. Fifty percent of children that received definitive care at a PTC were admitted to an ICU compared to 23.9% at a Level 1 ATC. There were 119 (9.7%) in-hospital deaths. Children aged ≤15 years who were treated at a Level 1 ATC had 6.1 times higher odds of not surviving their injuries than if treated at a PTC.
Children who received definitive care at a PTC had a survival advantage compared to those treated at a Level 1 ATC. Prospectively examining the processes of care for severely injured children may assist in identification of quality and system changes required to ensure optimal trauma care within the health-care system.
与在成人创伤中心（ATC）接受治疗相比，在儿科创伤中心（PTC）接受治疗是否能为受伤儿童带来生存优势，目前尚无定论。本研究探讨了澳大利亚新南威尔士州严重受伤的儿科创伤患者的创伤中心类型与院内死亡率之间的关联。
利用新南威尔士州创伤登记处2009 - 2014年的数据，对儿科患者特征（年龄≤15岁）、治疗情况和损伤结局进行回顾性分析。采用逻辑回归分析来研究院内死亡率与创伤中心类型之间的关联。
共有1230名儿童受重伤（即损伤严重度评分；ISS＞12），81.0%在PTC接受了确定性治疗。三分之二为男性，37.8%年龄在11 - 15岁之间，跌倒导致的损伤占32.0%。近一半（48.9%）的受伤儿童ISS在16至24之间，31.9%在25至39之间，3.8%的ISS在40至75之间。平均住院时间和中位住院时间分别为17.5天和5天。在PTC接受确定性治疗的儿童中有50%入住重症监护病房，而在一级ATC为23.9%。有119例（9.7%）院内死亡。1级ATC治疗的≤15岁儿童受伤后死亡几率比在PTC治疗高6.1倍。
与在1级ATC接受治疗的儿童相比，在PTC接受确定性治疗的儿童具有生存优势。前瞻性地研究重伤儿童的护理过程可能有助于确定医疗系统内确保最佳创伤护理所需的质量和系统变革。
