D. R. Gurciullo1, N. Denning1,3, V. P. Vasudevan2,4, L. S. Palmer2,4, J. M. Prince1,3 1Cohen Children’s Medical Center at Northwell Health,Division Of Pediatric Surgery,New Hyde Park, NY, USA 2Cohen Children’s Medical Center at Northwell Health,Department Of Pediatric Urology,New Hyde Park, NY, USA 3Zucker School of Medicine at Hofstra/Northwell,Department Of Surgery,Manhasset, NY, USA 4Zucker School of Medicine at Hofstra/Northwell,Department Of Urology,Manhasset, NY, USA
Introduction: In 2012, New York State began a process to transition from state recognition and accreditation of trauma centers to the American College of Surgeons Committee on Trauma (ACS-COT) system of trauma center verification. In 2015, our tertiary care children’s hospital transitioned from a NY State regional trauma center to an ACS-COT Level 1 pediatric trauma center. Improved outcomes for patients treated at designated trauma centers are well established. Recent literature has demonstrated that ACS-COT verification further improves outcomes for patients treated at adult trauma centers however, there is less data examining pediatric centers. In contrast to management of liver and spleen injuries, there is less standardization in pediatric renal trauma. As such, we sought to evaluate the impact of ACS-COT verification on management of renal injuries at a pediatric trauma center.
Methods: This is an IRB approved retrospective review of pediatric patients under 18 years of age admitted with a traumatic renal injury at our tertiary care children’s hospital from 2013 to 2017. Baseline demographics, including mechanism of injury, level of activation, and clinical status at presentation, were collected. In hospital and follow up data were recorded. Patient outcomes, treatment, and resource utilization were compared between patients treated before and after ACS-COT verification.
Results: 26 patients with renal injury were identified; 14 pre-ACS-COT verification and 12 post-ACS-COT verification. The two groups were similar in regard to age, trauma mechanism, level of trauma activation, admission hemoglobin and creatinine, and average grade of kidney injury (2.7 ± 1.4 vs 2.5 ± 1.3). 88.5 % of patients required no renal intervention; there were no nephrectomies and three nephron-sparing procedures. Descriptive statistical analysis demonstrated there was a small decrease in percentage of PICU admissions (57% vs 50%) and percentage of patients receiving a transfusion (28.6% vs 25%), and notable decreases in hospital length of stay (5.8 ± 5.7 vs 3.8 ± 3.5 days), percentage of repeat CT scans (42.9% vs 25%), and phlebotomy (6.2 ± 6.2 vs 4.3 ±4.8 blood draws). There was a large increase in the number of patients receiving urologic consultation from 38.5% to 66.7% post-verification (p = 0.16). There was a significant decrease in the percentage of patients who followed up with the trauma service post discharge, from 71.4% to 33.3% post-verification (p=0.05). There were no mortalities in either group.
Conclusion: This single institution observational study suggests improved patient outcomes and decreased resource utilization after ACS-COT verification. An increase in urology consultations post-verification demonstrates the recognition of the need for collaborative care. Interestingly, these potential inpatient improvements did not correlate with outpatient follow up. Larger, multi-institutional studies are needed to verify these findings.