EFFICACY OF PEDIATRIC TRAUMA CARE - RESULTS OF A POPULATION-BASED STUDY

To determine concordance between regional outcome and national norms with respect to pediatric injury diagnosis, severity, and mortality in a state lacking a well-organized trauma system, we compared summary data from all pediatric trauma-related hospital discharge abstracts compiled by the [New York State Department of Health] Statewide Planning and Reseach Cooperative [Mandatory Hospital Reporting] System (SPARCS), with comparable data from pediatric trauma centers participating in the National Pediatric Trauma Registry (NPTR), for similar epochs in the late 1980s. Analysis was based on 14,234 cases from SPARCS and 17,098 cases from NPTR. Data were grouped by principal anatomic diagnosis (ICD-9-CM N-code) and injury severity score (ISS), for each of which incidence and mortality were calculated, both individually and collectively, then compared item by item for sources of variance. Overall, the two data sets showed the expected discordance, with NPTR being skewed toward more complex and severe injury. However, when analyzed cell by cell, a striking degree of concordance emerged in both incidence and mortality for injuries of comparable severity in all but a few selected subsets. Isolated skeletal injuries were treated less frequently in pediatric trauma centers, and combined system injuries to the skeleton, brain, and internal organs were treated more frequently in pediatric trauma centers. However, while the fatality rates were similar between SPARCS and NPTR for most diagnoses, given comparable ISS, survival was some ten times greater in pediatric trauma centers for patients with either brain or internal injuries-the leading causes of pediatric injury mortality-and for skeletal injuries, when the injuries sustained were of moderately great severity. These data show that system triage of moderately to severely injured children to trauma centers with pediatric commitment and capabilities is both feasible and effective, and clearly increases survival of children with serious but still salvageable skeletal, brain, or internal injuries. We conclude that: (1) organized pediatric trauma systems save more children's lives, and (2) national norms are essential in setting goals for optimal pediatric trauma care. © 1993.