Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Am Surg. 2023 Nov;89(11):4508-4520. doi: 10.1177/00031348221121555. Epub 2022 Aug 17.
Pediatric trauma outcomes can vary across facilities, yet evidence on the relationship between facility bed size and pediatric trauma outcomes has been mixed. We aimed to identify how facility bed size might modify the impact of patient-level risk factors on mortality in pediatric trauma. We hypothesized that patient-level risk factors would have a stronger association with mortality at smaller trauma centers, and a weaker association with mortality at larger centers.
We used deidentified data obtained from the 2017-2018 Trauma Quality Programs registry, including patients ages 0-18 years of age who were admitted to the hospital. The primary outcome was in-hospital mortality. Facility bed size was dichotomized as large (>600 beds) vs small/medium (≤600 beds). Sensitivity analyses used 200 and 400 beds as alternative cutoffs. Interaction between facility bed size and patient characteristics was assessed using unadjusted logistic regression, with statistically significant interactions entered in a final, fully adjusted model.
The analysis included 171 810 patients (mean age 10 ± 5 years; 65%/35% male/female), including 28% treated in a large hospital and 1.2% who died during the hospitalization. Controlling for trauma center level (or subsetting to pediatric trauma centers only), larger bed size did not reduce mortality risk associated with patient characteristics such as injury mechanism, injury severity, or patient demographics.
Contrary to our hypothesis, greater facility bed size was not associated with reduced mortality risk associated with patient characteristics. Future studies are needed to identify hospital practices or characteristics that can attenuate the excess risk of known patient-level risk factors.
儿科创伤的结局可能因机构而异，但有关机构床位数与儿科创伤结局之间关系的证据一直存在分歧。我们旨在确定机构床位数如何改变患者个体风险因素对儿科创伤死亡率的影响。我们假设，患者个体风险因素与较小创伤中心的死亡率相关性更强，与较大中心的死亡率相关性更弱。
我们使用了 2017-2018 年创伤质量计划登记处获得的匿名数据，包括年龄在 0-18 岁之间住院的患者。主要结局是院内死亡率。机构床位数分为大型（>600 张床）和小型/中型（≤600 张床）。使用 200 张和 400 张床作为替代截止值进行敏感性分析。使用未调整的逻辑回归评估机构床位数与患者特征之间的交互作用，将具有统计学意义的交互作用纳入最终的完全调整模型。
分析纳入了 171810 名患者（平均年龄 10±5 岁；65%/35%为男性/女性），其中 28%在大型医院接受治疗，1.2%在住院期间死亡。在控制创伤中心水平（或仅将其分为儿科创伤中心）后，较大的床位数并未降低与患者特征相关的死亡率风险，如损伤机制、损伤严重程度或患者人口统计学特征。
与我们的假设相反，更大的机构床位数与降低与患者特征相关的死亡率风险无关。需要进一步研究以确定可以减轻已知患者个体风险因素的过度风险的医院实践或特征。
