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Lee SY, Jackson JE, Vukcevich O, Stokes SC, Leshikar H, Rinderknecht T, Kohler JE, Brown EG. Characteristics of operative pediatric trauma transfer patients. Am J Surg 2024; 227:224-228. [PMID: 37925308 DOI: 10.1016/j.amjsurg.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Pediatric patients treated at trauma centers demonstrate improved outcomes, but investigation of optimal resource utilization surrounding the transfer is ongoing. We evaluated characteristics of operative pediatric trauma transfer patients for resource optimization. METHODS A retrospective review of pediatric trauma patients transferred to a level 1 pediatric trauma center from 2009 to 2019 was performed. Patients were categorized by initial operative subspecialty. RESULTS Of 4164 transferred patients, 33.9 % required operative intervention. 65 % of operations were performed on orthopedic patients, who were significantly less injured compared to other patients. General surgery patients were more likely to undergo surgery on day of transfer compared to orthopedic patients (39.4%vs 56.3 %, OR 2.0, CI 1.4-2.8). CONCLUSIONS One-third of pediatric trauma transfer patients required operative intervention. The majority of surgeries were on orthopedic patients, who were less likely to undergo surgery on day of transfer. Critical evaluation of this patient population is required to safely utilize a less resource-intensive transfer process.
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Affiliation(s)
- Su Yeon Lee
- Department of surgery, Montefiore Medical Center, USA; Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, USA.
| | - Jordan E Jackson
- Department of Surgery, University of San Francisco- East Bay, USA.
| | | | - Sarah C Stokes
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, USA.
| | - Holly Leshikar
- Division of Pediatric Orthopedic Surgery, University of California Davis Medical Center, USA.
| | - Tanya Rinderknecht
- Division of Trauma, Acute Care Surgery, and Critical Care, University of California Davis Medical Center, USA.
| | - Jonathan E Kohler
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, USA.
| | - Erin G Brown
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, USA.
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Hosseinpour H, Magnotti LJ, Bhogadi SK, Colosimo C, El-Qawaqzeh K, Spencer AL, Anand T, Ditillo M, Nelson A, Joseph B. Interfacility transfer of pediatric trauma patients to higher levels of care: The effect of transfer time and level of receiving trauma center. J Trauma Acute Care Surg 2023; 95:383-390. [PMID: 36726199 DOI: 10.1097/ta.0000000000003915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Interfacility transfer of pediatric trauma patients to pediatric trauma centers (PTCs) after evaluation in nontertiary centers is associated with improved outcomes. We aimed to assess the outcomes of transferred pediatric patients based on their severity of the injury, transfer time, and level of receiving PTCs. METHODS This is a 3-year (2017-2019) analysis of the American College of Surgeons Trauma Quality Improvement Program database. All children (younger than 15 years) who were transferred from other facilities to Level I or II PTC were included and stratified by level of receiving PTCs and injury severity. Outcome measures were in-hospital mortality and major complications. RESULTS A total of 67,726 transferred pediatric trauma patients were identified, of which 52,755 were transferred to Level I and 14,971 to Level II. The mean ± SD age and median Injury Severity Score were 7 ± 4 years and 4 (1-6), respectively. Eighty-five percent were transported by ground ambulance. The median transfer time for Levels I and II was 93 (70-129) and 90 (66-128) minutes, respectively ( p < 0.001). On multivariable regression, interfacility transfers to Level I PTCs were associated with decreased risk-adjusted odds of in-hospital mortality among the mildly to moderately injured group (adjusted odds ratio, 0.59; p = 0.037) and severely injured group with a transfer time of less than 60 minutes (adjusted odds ratio, 0.27; p = 0.002). CONCLUSION Every minute increase in the interfacility transfer time is associated with a 2% increase in risk-adjusted odds of mortality among severely injured pediatric trauma patients. Factors other than the level of receiving PTCs, such as estimated transfer time and severity of injury, should be considered while deciding about transferring pediatric trauma patients to higher levels of care. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Hamidreza Hosseinpour
- From the Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
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White CR, Leshikar HB, White MR, White SR, Semkiw K, Farmer DL, Haus BM. Does the American College of Surgeons New Level I Children's Surgery Center Verification Affect Treatment Efficiency and Narcotic Administration in Treating Pediatric Trauma Patients with Femur Fracture? J Am Coll Surg 2023; 236:476-483. [PMID: 36729765 PMCID: PMC9924964 DOI: 10.1097/xcs.0000000000000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND In 2015, the American College of Surgeons (ACS) created a new hospital improvement program to enhance the performance of pediatric care in US hospitals. The Children's Surgery Verification (CSV) Quality Improvement Program is predicated on the idea that pediatric surgical patients have improved outcomes when treated at children's hospitals with optimal resources. Achieving ACS level I CSV designation at pediatric trauma centers may lead to greater benefits for pediatric trauma patients; however, the specific benefits have yet to be identified. We hypothesize that achieving the additional designation of ACS level I CSV is associated with decreased narcotic use perioperatively and improved efficiency when managing pediatric patients with femur fractures. STUDY DESIGN This study is a retrospective analysis of traumatic pediatric orthopaedic femur fractures treated at a verified level I pediatric trauma center before and after CSV designation (2010 to 2014 vs 2015 to 2019). Efficiency parameters, defined as time from admission to surgery, duration of surgery, and duration of hospital stay, and narcotic administration in oral morphine equivalents (OMEs) were compared. RESULTS Of 185 traumatic femur fractures analyzed, 80 occurred before meeting ACS level I CSV criteria, and 105 occurred after. Post-CSV, there was a significant decrease in mean wait time from admission to surgery (16.64 hours pre-CSV, 12.52 hours post-CSV [p < 0.01]) and duration of hospital stay (103.49 hours pre-CSV, 71.61 hours post-CSV [p < 0.01]). Narcotic usage was significantly decreased in both the preoperative period (40.61 OMEs pre-CSV, 23.77 OMEs post-CSV [p < 0.01]) and postoperative period (126.67 OMEs pre-CSV, 45.72 OMEs post-CSV [p < 0.01]). CONCLUSIONS Achieving ACS level I CSV designation is associated with increased efficiency and decreased preoperative and postoperative narcotic use when treating pediatric trauma patients.
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Affiliation(s)
- Carter R White
- From the University of California, Davis, School of Medicine, Sacramento, CA (CR White, Leshikar, MR White, Farmer, Haus)
| | - Holly B Leshikar
- From the University of California, Davis, School of Medicine, Sacramento, CA (CR White, Leshikar, MR White, Farmer, Haus)
- the University of California, Davis, Children’s Hospital Department of Orthopaedic Surgery, Sacramento, CA (Leshikar, Haus)
| | - Micaela R White
- From the University of California, Davis, School of Medicine, Sacramento, CA (CR White, Leshikar, MR White, Farmer, Haus)
| | | | - Karen Semkiw
- the University of California, Davis, Children’s Hospital Department of General Surgery, Sacramento, CA (Semkiw, Farmer)
| | - Diana L Farmer
- From the University of California, Davis, School of Medicine, Sacramento, CA (CR White, Leshikar, MR White, Farmer, Haus)
- the University of California, Davis, Children’s Hospital Department of General Surgery, Sacramento, CA (Semkiw, Farmer)
| | - Brian M Haus
- From the University of California, Davis, School of Medicine, Sacramento, CA (CR White, Leshikar, MR White, Farmer, Haus)
- the University of California, Davis, Children’s Hospital Department of Orthopaedic Surgery, Sacramento, CA (Leshikar, Haus)
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Tan JCL, Ang PH, Chong SL, Lee KP, Ong GYK, Zakaria NDB, Pek JH. Differences in Utilisation of the General and Paediatric Emergency Departments by Paediatric Patients. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020; 49:948-954. [PMID: 33463652 DOI: 10.47102/annals-acadmedsg.2020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Paediatric patients presenting to the general emergency departments (EDs) differ from those presenting to paediatric EDs. General EDs vary in preparedness to manage paediatric patients, which may affect delivery of emergency care with varying clinical outcomes. We aimed to elucidate the differences in utilisation patterns of paediatric and general EDs by paediatric patients. METHODS This study was conducted in a public healthcare cluster in Singapore consisting of 4 hospitals. A retrospective review of the medical records of paediatric patients, defined as age younger than 16 years old, who attended the EDs from 1 January 2015 to 31 December 2018, was performed. Data were collected using a standardised form and analysed. RESULTS Of the 704,582 attendances, 686,546 (97.4%) were seen at the paediatric ED. General EDs saw greater number of paediatric patients in the emergent (P1) category (921 [5.1%] versus 14,829 [2.2%]; P<0.01) and those with trauma-related presentations (6,669 [37.0%] vs 108,822 [15.9%]; P<0.01). The mortality of paediatric patients was low overall but significantly higher in general EDs (39 [0.2%] vs 32 [0.005%]; P<0.01). Seizure, asthma/bronchitis/bronchiolitis, allergic reaction, cardiac arrest and burns were the top 5 diagnoses that accounted for 517 (56.1%) of all emergent (P1) cases seen at general EDs. CONCLUSION General EDs need to build their capabilities and enhance their preparedness according to the paediatric population they serve so that optimal paediatric emergency care can be delivered, especially for critically ill patients who are most in need of life-saving and timely treatment.
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