Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients.

Autor: Rubens JH; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland., Ahmed OZ; Department of Surgery, Children's National Health System, Washington, District of Columbia., Yenokyan G; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Stewart D; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland., Burd RS; Department of Surgery, Children's National Health System, Washington, District of Columbia., Ryan LM; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: lyran17@jhmi.edu.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2020 Feb; Vol. 246, pp. 153-159. Date of Electronic Publication: 2019 Oct 03.
DOI: 10.1016/j.jss.2019.08.008
Abstrakt: Background: Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS).
Materials and Methods: We performed a retrospective cohort study at two level I pediatric trauma centers.
Inclusion Criteria: <15 y old with blunt or penetrating injury. We used univariate and multivariate logistic regression analyses to determine associations between trauma activation, ED length of stay (LOS), and hospital LOS with demographic and clinical characteristics.
Results: We identified 1161 patients: 40.1% arrived by self-transport and 59.9% by EMS. Self-transport patients were less likely to have an abnormal Glasgow Coma Scale score < 15 (2.1% versus 22.0%, P < 0.001) and Injury Severity Score > 15 (2.4% versus 11.7%, P < 0.001). Trauma activation was initiated in 52.5% of patients, occurring less often in self-transport than EMS patients (2.4% versus 86.2%, P < 0.001). Trauma activation rate was negatively associated with arrival by self-transport (odds ratio [OR] 0.001, 95% CI 0.00-0.003), positively associated with Glasgow Coma Scale <15 (OR 25.9, 95% CI 6.6-101.2) and site (OR 15.4, 95% CI 6.3-37.5) but not with Injury Severity Score >15 (OR 2.8, 95% CI 0.8-9.2). Self-transport arrival was associated with longer ED LOS (estimated regression slope 0.47, 95% CI 0.13-0.82).
Conclusions: Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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