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Factors Associated with Time to Arrival at a Regional Pediatric Trauma Center

Published online by Cambridge University Press:  27 November 2015

Folafoluwa O. Odetola ,
N. Clay Mann ,
Kristine W. Hansen  and
Susan L. Bratton
Folafoluwa O. Odetola*
Affiliation:
The Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan, USA
N. Clay Mann
Affiliation:
The Department of Pediatrics, University of Utah School of Medicine, Intermountain Injury Control Research Center, Salt Lake City, Utah, USA
Kristine W. Hansen
Affiliation:
The Department of Pediatrics, University of Utah School of Medicine, Intermountain Injury Control Research Center, Salt Lake City, Utah, USA
Susan L. Bratton
Affiliation:
The Department of Pediatrics, University of Utah School of Medicine, Intermountain Injury Control Research Center, Salt Lake City, Utah, USA
*
Correspondence: Folafoluwa O. Odetola, MD, MPH 6C07, 300 North Ingalls Street Ann Arbor Michigan, USA 48109 E-mail: [email protected]
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Abstract

Objective

The goal of this study was to test the hypothesis that the prehospital time between injury and arrival at a trauma center for critically injured children is associated with patient injury severity and mode of transport.

Methods

Secondary analysis of prospectively collected data on children 0-17 years of age admitted with traumatic injuries to a designated Level I pediatric trauma center from January 1, 2006 through September 30, 2007 was conducted. Multivariate regression methods were used to assess for factors independently associated with prehospital time.

Results

Of 1,175 admissions during the study period, only 355 (30%) had a prehospital time within 60 minutes of injury. Prehospital time within 60 minutes of injury was associated with higher frequency of coma, higher mean injury severity scores (ISS), and greater frequency of admission to the intensive care unit when compared with prehospital time beyond 60 minutes of injury. Children who arrived at the trauma center within 60 minutes versus beyond 60 minutes were 13-fold (odds ratio [OR]: 12.9; 95% Confidence Interval [CI], 7.6-22.0) more likely to be transported via air ambulance than a private vehicle, and had 4.8-fold greater odds (95% CI, 2.2-10.3) of transport via ground ambulance than private vehicle. For each kilometer of distance between the injury zip code and the trauma center, the odds of arrival within 60 minutes versus beyond 60 minutes decreased by 15% (OR: 0.85; 95% CI, 0.79-0.91).

Conclusion

Field triage and decision making appeared to correlate with severity of patient injury with expeditious transport of the most severely injured children to definitive trauma care. This finding serves as important groundwork that might enable further study into factors that influence triage and overall prehospital care for critically injured children.

OdetolaFO , MannNC , HansenKW , BrattonSL . Factors Associated with Time to Arrival at a Regional Pediatric Trauma Center. Prehosp Disaster Med. 2016;31(1):4–9.

Keywords

hospital chargeshospitalized childreninjurieslength of staymortality
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 1 , February 2016 , pp. 4 - 9
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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References

1. West, JG, Trunkey, DD, Lim, RC. Systems of trauma care. A study of two counties. Arch Surg. 1979;114(4):455-460.Google Scholar
2. West, JG, Cales, RH, Gazzaniga, AB. Impact of regionalization. The Orange County experience. Arch Surg. 1983;118(6):740-744.Google Scholar
3. Cales, RH. Trauma mortality in Orange County: the effect of implementation of a regional trauma system. Ann Emerg Med. 1984;13(1):1-10.Google Scholar
4. Shackford, SR, Hollingworth-Fridlund, P, Cooper, GF, Eastman, AB. The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma. 1986;26(9):812-820.CrossRefGoogle ScholarPubMed
5. Potoka, DA, Schall, LC, Gardner, MJ, Stafford, PW, Peitzman, AB, Ford, HR. Impact of pediatric trauma centers on mortality in a statewide system. J Trauma. 2000;49(2):237-245.Google Scholar
6. Hulka, F, Mullins, RJ, Mann, NC, et al. Influence of a statewide trauma system on pediatric hospitalization and outcome. J Trauma. 1997;42(3):514-519.Google Scholar
7. Pollack, MM, Alexander, SR, Clarke, N, Ruttimann, UE, Tesselaar, HM, Bachulis, AC. Improved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and non-tertiary care facilities. Crit Care Med. 1991;19(2):150-159.Google Scholar
8. Nakayama, DK, Copes, WS, Sacco, W. Differences in trauma care among pediatric and non-pediatric trauma centers. J Pediatr Surg. 1992;27(4):427-431.Google Scholar
9. Cooper, A, Barlow, B, DiScala, C, String, D, Ray, K, Mottley, L. Efficacy of pediatric trauma care: results of a population-based study. J Pediatr Surg. 1993;28(3):299-303.Google Scholar
10. Potoka, DA, Schall, LC, Ford, HR. Improved functional outcome for severely injured children treated at pediatric trauma centers. J Trauma. 2001;51(5):824-832.Google Scholar
11. Trunkey, DD. Trauma. Sci Am. 1983;249(2):28-35.Google Scholar
12. Franklin, F, Doelp, A. (eds). Shock-Trauma. New York City, New York USA: St. Martin’s Press; 1980.Google Scholar
13. Sampalis, JS, Denis, R, Frechette, P, Brown, R, Fleiszer, D, Mulder, D. Direct transport to tertiary trauma centers versus transfer from lower level facilities. J Trauma. 1997;43(2):288-296.Google Scholar
14. Houtchens, BA. Major trauma in the rural mountain west. J Am Coll Emergency Phys. 1977;6(8):343-350.CrossRefGoogle ScholarPubMed
15. Baker, SP, Whitfield, RA, O’Neill, B. Geographic variations in mortality from motor vehicle crashes. N Engl J Med. 1987;316(22):1384-1387.Google Scholar
16. Waller, JA, Curran, R, Noyes, F. Traffic deaths. A preliminary study of urban and rural fatalities in California. Calif Med. 1964;101(4):272-276.Google Scholar
17. Axelrod, DA, Guidinger, MK, Finlayson, S, et al. Rates of solid-organ wait-listing, transplantation, and survival among residents of rural and urban areas. JAMA. 2008;299(2):202-207.Google Scholar
18. Tonelli, M, Klarenbach, S, Rose, C, Wiebe, N, Gill, J. Access to kidney transplantation among remote- and rural-dwelling patients with kidney failure in the United States. JAMA. 2009;301(16):1681-1690.Google Scholar
19. Penfold, RB, Chisolm, DJ, Nwomeh, BC, Kelleher, KJ. Geographic disparities in the risk of perforated appendicitis among children in Ohio: 2001-2003. Int J Health Geogr. 2008;7:56.Google Scholar
20. University of Washington Rural Health Research Center. Rural-urban commuting area codes. http://depts.washington.edu/uwruca/codes.html. Accessed March 1, 2015.Google Scholar
21. Baker, SP, O’Neill, B, Haddon, W Jr., Long, WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-196.Google Scholar
22. Champion, HR, Copes, WS, Sacco, WJ, et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990;30(11):1356-1365.Google Scholar
23. Teasdale, G, Jennett, B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2(7872):81-84.CrossRefGoogle ScholarPubMed
24. Durkin, MS, Olsen, S, Barlow, B, Virella, A, Connolly, ES Jr. The epidemiology of urban pediatric neurological trauma: evaluation of, and implications for, injury prevention programs. Neurosurgery. 1998;42(2):300-310.Google Scholar
25. Petri, RW, Dyer, A, Lumpkin, J. The effect of prehospital transport time on the mortality from traumatic injury. Prehosp Disaster Med. 1995;10(1):24-29.CrossRefGoogle ScholarPubMed
26. Odetola, FO, Miller, WC, Davis, MM, Bratton, SL. The relationship between the location of pediatric intensive care unit facilities and child death from trauma: a county-level ecologic study. J Pediatr. 2005;147(1):74-77.Google Scholar
27. Lerner, EB, Moscati, RM. The golden hour: scientific fact or medical “urban legend?” Acad Emerg Med. 2001;8(7):758-760.Google Scholar
28. Stroud, MH, Prodhan, P, Moss, MM, Anand, KJ. Redefining the golden hour in pediatric transport. Pediatr Crit Care Med. 2008;9(4):435-437.Google Scholar