Children Fare Better at Pediatric Trauma Centers

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A study by researchers at the Medical College of Wisconsin in Milwaukee and Children’s Research Institute concludes that the risk of death for injured children is significantly lower when care is provided in pediatric trauma centers than in non–pediatric centers. Children’s Research Institute is part of the Children’s Hospital and Health System. The study on “Outcomes and Delivery of Care in Pediatric Injury” is published in the January 2006 Journal of Pediatric Surgery.

“Because of their unique physiology, children have particular needs and present challenges to predominantly adult-oriented trauma care delivery systems. There appears to be substantial room for improvement in current pediatric trauma triage systems, and this study suggests that we can save more children’s lives,” according to lead researcher John C. Densmore, M.D., a resident in the department of surgery at the Medical College.

Using the 2000 Kids’ Inpatient Database (KID), an administrative database of the Healthcare Cost and Utilization Project containing more than 2.5 million inpatient discharge records from 27 states, the researchers analyzed nearly 80,000 pediatric trauma cases. First, they found that nearly 90 percent of injured children were treated at adult hospitals or in children’s units at adult hospitals. They also found that the 10.7 percent who were treated at children’s hospitals had significantly lower mortality rates, lengths of stay and hospital bills.

• Mortality rates were lowest (0.9 percent) in children’s hospitals, somewhat worse (1.4 percent) in adult hospitals and highest (2.4 percent) in children’s units within adult hospitals

• Lengths of stay greater than the 90th percentile occurred least often at children’s hospitals (8.9 percent), somewhat more often in adult hospitals (9.7 percent) and most often in children’s units (17.2 percent)

• Hospital charges above $15,000 were more likely in a children’s unit (32.4 percent) than in an adult hospital (22.2 percent) or children’s hospital (20.2 percent)

In 2002, the most recent year for which data are available, there were 18,953 injury-related deaths among children aged one to 20 years. The study’s data indicate that the majority of the youngest and most severely injured children receive care in hospitals with poorer outcomes.

“The geographic disparity and limited number of pediatric surgeons, specialists, and children’s hospitals have been cited as the reason for problems in current pediatric trauma care. We hope this study helps people understand the need for pediatric-specific trauma care throughout the United States,” says Keith T. Oldham, M.D., professor and chief of surgery and co-author of the study.

Other authors include Karen S. Guice, M.D., clinical professor of pediatrics surgery, and by Hyun J. Limb, M.D., assistant professor in the division of biostatistics in the Health Policy Institute, at the Medical College.

The study was supported in part by the U.S. Department of Health and Human Services and by the American Pediatric Surgical Association Outcomes Center.

“A National Evaluation of the Effect of Trauma Center Care on Mortality” was conducted by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of Washington School of Medicine and published in the January 26, 2006, edition of The New England Journal of Medicine.

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