Philadelphia, Pa. — Injured children who receive care at trauma centers certified to treat children have better survival rates than children treated at adult trauma centers, according to a recent Pennsylvania study. The better outcomes, said the researchers, may occur because pediatric trauma centers provide care specifically tailored to children, rather than following medical practices designed for adults.
The study of 13,000 injured children, conducted by trauma teams at The Children’s Hospital of Philadelphia and the Children’s Hospital of Pittsburgh, was published in the August issue of the Journal of Trauma. "Parents should find out in advance where the nearest certified pediatric trauma center is located, and request prompt transfer there if their child is injured," said Perry W. Stafford, M.D., director of the Trauma Center at The Children’s Hospital of Philadelphia, and a co-author of the study. "This research underscores the importance of the having standards of care that are geared to the special needs of injured children."
Using information collected by the Pennsylvania Trauma Systems Foundation, an accrediting agency for trauma centers, the researchers analyzed records of more than 13,000 injured children seen in 26 hospital-based trauma centers. Two of the centers were pediatric trauma centers (The Children’s Hospital of Philadelphia and the Children’s Hospital of Pittsburgh), five were adult trauma centers with added qualifications in pediatrics, and the remaining 19 were adult trauma centers.
To be accredited as a pediatric trauma center, a hospital must have comprehensive pediatric services that include full-time availability of pediatric surgeons, neurosurgeons, orthopedic surgeons, emergency physicians, pediatric anesthesiologists and critical care specialists.
The researchers found that, overall, children treated at pediatric trauma centers or at the adult centers with added pediatric qualifications had significantly better outcomes than those treated at adult trauma centers. For instance, the mortality rate for all pediatric injuries was 3.6 percent at pediatric trauma centers, compared to 8 percent at level I adult trauma centers, and 4.7 percent at level II adult trauma centers (level I indicates more comprehensive services than level II).
Furthermore, survival rates for children who sustained head, spleen and liver injuries were significantly better at pediatric trauma centers compared to all other trauma centers. Mortality rates, regardless of severity, were 6.6 percent (head injuries), 9.1 percent (liver injuries) and 5.8 percent (spleen injuries) at pediatric trauma centers, compared to figures such as 21.3 percent (head injuries in children at level I adult trauma centers) and 32.3 percent (liver injuries in children at level II adult trauma centers).
More than 1.5 million childhood injuries occur each year, resulting in 500,000 hospitalizations and between 15,000 and 20,000 deaths. Regional pediatric trauma centers have been developed to provide the best care for injured children, but given the relative shortage of such centers, many injured children receive care at adult trauma centers, Dr. Stafford said.
However, optimal care for particular injuries to children may be different than for corresponding adult injuries. For instance, it is often better to treat spleen injuries in children without surgery, in contrast to adult injuries, in which surgery is more frequently recommended. Yet the study found that children had injured spleens removed 16 to 28 percent of the time in adult trauma centers, compared to less than 3 percent of the time in pediatric trauma centers. The authors say such results suggest that "in adult trauma centers, injured children may be treated according to adult norms rather than pediatric standards."
Collaborating on the study with Dr. Stafford was Henri R. Ford, M.D., director of the Benedum Pediatric Trauma Center at the Children’s Hospital of Pittsburgh.
Founded in 1855 as the nation’s first pediatric hospital, The Children’s Hospital of Philadelphia is recognized today as one of the leading treatment and research facilities in the world. Through its longstanding commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children’s Hospital has fostered discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique outreach and public service programs have brought the 381-bed hospital recognition as a leading advocate for children from before birth through age 19. ###
Note to editors: The Children’s Hospital of Philadelphia is the only Level I pediatric trauma center in eastern Pennsylvania, one of only two such centers in the entire state. Children’s Hospital was the first accredited pediatric trauma center in Pennsylvania, having received that designation in 1986. Trauma center accreditation is provided by the Pennsylvania Trauma Systems Foundation, a nonprofit organization formed by Pennsylvania Act 45. More than 1,000 children are treated here annually for traumatic injuries. In addition to comprehensive pediatric medical services and high standards of training, a level I pediatric trauma center is required to provide education about injury prevention to healthcare professionals and members of the public, to evaluate its own programs, and to conduct trauma research. For more details about the pediatric trauma center at The Children’s Hospital of Philadelphia, including injury prevention tips for parents, see http://safekids.chop.edu.
Perry W. Stafford, M.D., has been director of the Pediatric Trauma Center at The Children’s Hospital of Philadelphia since 1995. He is board-certified in general and pediatric surgery as well as surgical critical care and nutrition. Among his professional positions, he is a fellow of the American College of Surgery, the American Academy of Pediatrics and the American College of Critical Care Medicine. He is a member of many state and national committees dealing with childhood injury prevention and care, and is a frequent contributor to the scientific and lay literature.
Materials provided by The Children's Hospital of Philadelphia. Note: Content may be edited for style and length.
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