Citation

Odetola FO, Mann NC, Hansen KW, Patrick S, Bratton SL. Arch. Pediatr. Adolesc. Med. 2010; 164(3): 277-282.

Affiliation

300 N Ingalls St, Rm 6C07, Ann Arbor, Michigan 48109. fodetola@med.umich.edu.

Copyright

(Copyright © 2010, American Medical Association)

DOI

10.1001/archpediatrics.2009.285

PMID

20194263

Abstract

OBJECTIVE: To determine whether mortality and length of stay at a pediatric trauma center differ between patients admitted by inter-hospital transfer and those admitted directly from the injury scene. DESIGN: Analysis of prospectively collected data from a pediatric trauma center database. SETTING: A designated regional level I pediatric trauma center. PARTICIPANTS: Injured children from birth to 17 years of age hospitalized between January 1, 2006, and September 30, 2007. Main Exposure Incident in-hospital mortality rates and length of stay at the trauma center were compared between patients admitted directly and those admitted by inter-hospital transfer, controlling for potential confounders. OUTCOME MEASURES: In-hospital mortality and duration of hospitalization. RESULTS: Of 2192 patients admitted to the trauma center, 1175 (53.6%) were admitted directly from the injury scene. Patients admitted by inter-hospital transfer had higher injury severity and lower Glasgow Coma Scale scores at admission (P < .01). Of 31 deaths during the study period, 26 (83.9%) were among patients admitted by inter-hospital transfer. These patients had a 7-fold higher unadjusted incident rate of death (incidence rate ratio, 7.16; 95% confidence interval, 2.49-20.58) compared with those admitted directly. This finding remained (incidence rate ratio, 3.01; 95% confidence interval, 1.01-8.98) after adjustment for injury severity and Glasgow Coma Scale scores, elapsed time from injury until admission at the trauma center, and age. Among survivors, patients admitted by inter-hospital transfer stayed longer in the hospital than those admitted directly. CONCLUSION: Pediatric trauma center mortality rates are lower among children admitted directly from the injury scene compared with those admitted by inter-hospital transfer.

Language: en