Atraumatic Transition from a Pediatric Emergency Center to a Pediatric Trauma Center: A Fight for Better Outcomes

Abstract

Opening a new pediatric trauma center (PTC) is a sizable undertaking. A pediatric trauma team of specialists must be assembled, appropriate equipment and facilities prepared, and staff educated. Our PTC opened in May 2016, before that we had a pediatric emergency center. This study aimed to evaluate initial performance, and compare practices and outcomes before and after becoming a PTC. A review of prospectively collected data using our hospital's Trauma Registry. We compared patient profiles and outcomes 4.5 years before and one year after our hospital became a PTC. Demographic variables, outcomes, Injury Severity Score, and surgical interventions were compared. Chi Squared analysis and t test were used, with significance defined as P < 0.05. For the 4.5 years before opening the PTC, we averaged 96 pediatric trauma admissions annually. After opening, we had 289 admissions in one year, (146% increase, P < 0.05). Mean Injury Severity Score significantly increased from 3.7 to 5.3 postopening (P < 0.05), as did the number of surgical interventions from 19 to 88 (P < 0.001), but mortality did not change (no deaths). Transfers out of the hospital significantly decreased (3.8%) compared with preopening (10.4%, P = 0.03), whereas transfers into the hospital significantly increased, (38 compared with 62, P = 0.003). When mode of transportation was compared, pre- and postopening of the PTC, patient transport by air increased from 3 per cent to 35 per cent (P < 0.001). Transitioning from a pediatric emergency center to a PTC resulted in increased patient volumes, presentation of more severely injured patients, and increased surgical interventions, without a change in mortality.