B. C. Gulack1, J. E. Keenan1, D. P. Nussbaum1, B. R. Englum1, O. O. Adibe1, M. L. Shapiro1, J. E. Scarborough1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction: Previous studies have demonstrated improvement in the survival of pediatric trauma patients treated at American College of Surgeons (ACS) verified pediatric trauma centers. However, it is not known whether the level of pediatric trauma center verification, Level 1 (PTC1) versus Level 2 (PTC2), has any effect on outcomes.
Methods: We performed a review of the research data set (RDS) from the National Trauma Data Bank (NTDB) from 2007-2011, including all pediatric patients less than 16 years of age who were treated at an ACS verified adult level I trauma center. Patients were excluded if they were transferred to another facility. Patients were subdivided on the basis of trauma center verification: PTC1, PTC2, or trauma center without a pediatric ACS verification. These groups were compared with regards to baseline demographics, injury severity, and outcomes. Multivariable logistic regression was then performed to determine the independent association of ACS pediatric verification and in-hospital mortality.
Results: A total of 124,773 patients were included in the study, 63,746 (51.1%) of which presented to a PTC1 while 7,562 (6.1%) presented to a PTC2 and 53,465 (42.8%) presented to a trauma center with no pediatric ACS verification. Unadjusted analysis demonstrated significant differences in in-hospital mortality at PTC1s (1.6%) compared to PTC2s (2.4%) and trauma centers without pediatric ACS verification (2.1%, p<0.001). In multivariable logistic regression, compared to hospitals without pediatric ACS verification, PTC1s had a significantly reduced in-hospital mortality (Adjusted Odds Ratio [AOR] (95% Confidence Interval [CI]): 0.85 (0.73, 0.99), Figure) while PTC2s did not (AOR (95% CI): 1.07 (0.80, 1.42).
Conclusion: Pediatric patients treated at centers verified as a level I pediatric trauma center by the ACS have a significantly decreased odds of in-hospital mortality compared to those treated at non-verified centers, however this is not seen with regards to PTC2s. Further investigation is necessary in order to determine if more stringent requirements are necessary for PTC2 verification.
