M. Vasterling4, R. Moreci1, S. White4, A. A. Smith1, J. A. Zagory2,3 1Louisiana State University Health Sciences Center, Department Of Surgery, New Orleans, LA, USA 2Louisiana State University Health Sciences Center, Division Of Pediatric Surgery, New Orleans, LA, USA 3Children’s Hospital of New Orleans, Department Of Pediatric Surgery, New Orleans, LA, USA 4Louisiana State University Health Sciences Center, School Of Medicine, New Orleans, LA, USA
Introduction:
Firearm injury has become the leading cause of pediatric trauma death in the United States. Optimal management of pediatric trauma patients with gunshot wounds (GSWs) remains a crucial concern, specifically in efficiently utilizing available healthcare resources. Previous studies fail to demonstrate substantial differences in outcomes of pediatric GSW patients receiving care at an adult (ATC) vs pediatric trauma center (PTC). The objective of the study was to evaluate differences in care of pediatric GSW patients following the implementation of the PTC.
Methods:
A retrospective review was performed of trauma registries from both the primary ATC and PTC in an urban metropolitan area. All pediatric patients (≤ 14 years old) with a GSW from March 2020 – April 2023 were included in the study. The cohort was divided into three groups: March 2020 – March 2021 (pre-implementation prior to PTC), April 2021 – April 2022 (mid-implementation when PTC started taking anatomic/physiologic evidence of injury) and May 2022 – April 2023 (post-implementation where PTC added taking trauma activation criteria by mechanism). All data was extracted from the two trauma registries and included demographic (gender, race, ethnicity, age, and adult vs pediatric trauma registry) and clinical (injury severity score, transport mode, and mortality) variables.
Results:
A total of 214 patients were included in the study. Of these, 33.6% (n=72) were in the pre-implementation group, 37.9% (n=81) in the mid-implementation group, and 28.5% (n=61) were in the post-implementation group. The majority of injuries were in Black, non-Hispanic males with a median age of 12 (0-14). When analyzing the number of patients in each trauma registry, there were significantly more patients in the pediatric trauma registry following initiation of implementation (43.1% vs 49.4% vs 73.8%, p=0.001). The majority of patients presented by ambulance, with a mild injury severity score (1-8), and without hospital fatalities. These findings did not differ in the mid- or post- implementation groups. When comparing patients presenting at the PTC vs ATC, white children were more likely to be brought to the PTC (OR 0.16 [0.04-0.69], p=0.01) and had a lower mortality rate (OR 0.04 [0.00-0.40], p=0.006).
Conclusion:
We observed the expected trend toward increasing trauma patients at the pediatric trauma hospital. This early implementation phase signifies a crucial stage during maturation of this new trauma system, including its impact on hospital resources. As this trauma system matures, it is important to continue to assess for any developing disparities.