@article{ref1,
title="Effects of establishing a trauma center on the mortality rate among injured pediatric patients in Japan",
journal="PLoS one",
year="2019",
author="Muguruma, Takashi and Toida, Chiaki and Gakumazawa, Masayasu and Yogo, Naoki and Shinohara, Mafumi and Takeuchi, Ichiro",
volume="14",
number="5",
pages="e0217140-e0217140",
abstract="INTRODUCTION: It remains unclear whether trauma centers are effective for the treatment of injured pediatric patients. The aim of this study was to evaluate children's mortality before and after the establishment a trauma center by using standard mortality ratios (SMR) and a modified observed-expected chart. <br><br>METHODS: This was a single center, retrospective chart review study that included injured pediatric patients (age <16 years) who were transported to our trauma center by the emergency medical services from 2012 to 2016 in Japan. <br><br>RESULTS: Our study included 143 subjects: 45 (31%) were preschoolers aged < 6 years, and 43 (30%) had an injury severity score (ISS) ≥ 16. After the trauma centers established, the number of patients increased (70% increase per month), as did the number of the patients with an ISS of 41-75. The percentage of indirect transportations was significantly higher in the trauma center than in the non-trauma center (49% vs. 28%; p < 0.05). The SMR was significantly lower in the trauma-center than in the non-trauma center (0.461 vs. 0.589; p < 0.05). The mean value of the modified observed-expected chart was significantly higher in the trauma-center than in the non-trauma center (4.6 vs. 2.3; p < 0.05). For the patients who were directly transferred to our center, the transfer distance was greater in the trauma-center than in the non-trauma center (6.8 vs. 6.2 km; p < 0.05). The time interval from hospital admission to initiation of computed tomography (15.5 vs. 33 minutes; p < 0.05) and to definitive care (44 vs. 64.5 minutes; p < 0.05) decreased in the after group compared to the non-trauma center. <br><br>CONCLUSIONS: The results of our study revealed that the centralization of pediatric injured pediatric patients in trauma centers improved the mortality rate in this population in Japan.<p /> <p>Language: en</p>",
language="en",
issn="1932-6203",
doi="10.1371/journal.pone.0217140",
url="http://dx.doi.org/10.1371/journal.pone.0217140"
}