Alexander Matthew, Zaghal Ahmad, Wetjen Kristel, Shelton Julia, Shilyansky Joel
University of Iowa Departments of Surgery, Iowa City, IA.
University of Iowa Departments of Surgery, Iowa City, IA; University of Iowa Stead Family Children's Hospital.
J Pediatr Surg. 2019 Jan;54(1):155-159. doi: 10.1016/j.jpedsurg.2018.10.004. Epub 2018 Oct 10.
We sought to evaluate value impact of transition from an adult trauma center treating children (ATC) to a verified pediatric trauma center (PTC) in children with blunt splenic injury (BSI).
Children with BSI from FY 2005 to FY 2017 were extracted from the hospital trauma registry. February 2009 distinguished "ATC" treated children from "PTC" treated children. Cohorts were subcategorized into "isolated injury" and "multisystem injury". Quality and financial characteristics were statistically compared. Analysis of covariance was used to evaluate changes in quality and financial trends over the transition period. A multiple linear regression was performed to identify variables independently predictive of hospital and professional charges.
126 children with BSI were identified (ATC, n = 56; PTC, n = 70). Splenic procedure rates and hospital charges decreased. Quality and cost metrics for isolated BSI remained unchanged while multisystem BSI children experienced improvements. PTC designation, ISS, splenic procedure, isolated BSI, average hospital LOS, and mortality were all independently predictive of hospital and professional charges.
PTC verification improves the value of BSI management, but the associated decrease in operative rate is only partially responsible. Multisystem injury children experience the greatest value benefit from PTC verification.
Treatment and cost-effectiveness study.
Level III.
我们试图评估从成人创伤中心（ATC）治疗儿童转变为经认证的儿科创伤中心（PTC）对钝性脾损伤（BSI）儿童的价值影响。
从医院创伤登记处提取2005财年至2017财年患有BSI的儿童。2009年2月区分了接受“ATC”治疗的儿童和接受“PTC”治疗的儿童。队列被进一步细分为“单纯损伤”和“多系统损伤”。对质量和财务特征进行统计学比较。采用协方差分析评估过渡期间质量和财务趋势的变化。进行多元线性回归以确定独立预测医院和专业费用的变量。
共识别出126例BSI儿童（ATC组，n = 56；PTC组，n = 70）。脾手术率和医院费用降低。单纯性BSI的质量和成本指标保持不变，而多系统BSI儿童的情况有所改善。PTC指定、损伤严重度评分（ISS）、脾手术、单纯性BSI、平均住院时间和死亡率均独立预测医院和专业费用。
PTC认证提高了BSI管理的价值，但手术率的相关下降只是部分原因。多系统损伤儿童从PTC认证中获得的价值益处最大。
治疗与成本效益研究。
三级。
