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

Jessica H. Rubens, Omar Z. Ahmed, Gayane Yenokyan, Dylan Stewart, Randall S. Burd, Leticia Manning Ryan

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)153-159
Number of pages7
JournalJournal of Surgical Research
Volume246
DOIs
StatePublished - Feb 1 2020

Fingerprint

Pediatrics
Wounds and Injuries
Length of Stay
Emergency Medical Services
Odds Ratio
Hospital Emergency Service
Glasgow Coma Scale
Injury Severity Score
Demography
Trauma Centers
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis

Keywords

  • Pediatric trauma
  • Self-transport
  • Trauma activation

ASJC Scopus subject areas

  • Surgery

Cite this

Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients. / Rubens, Jessica H.; Ahmed, Omar Z.; Yenokyan, Gayane; Stewart, Dylan; Burd, Randall S.; Ryan, Leticia Manning.

In: Journal of Surgical Research, Vol. 246, 01.02.2020, p. 153-159.

Research output: Contribution to journalArticle

Rubens, Jessica H. ; Ahmed, Omar Z. ; Yenokyan, Gayane ; Stewart, Dylan ; Burd, Randall S. ; Ryan, Leticia Manning. / Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients. In: Journal of Surgical Research. 2020 ; Vol. 246. pp. 153-159.
@article{901f70816eba48e4a98e937232479ee6,
title = "Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients",
abstract = "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.",
keywords = "Pediatric trauma, Self-transport, Trauma activation",
author = "Rubens, {Jessica H.} and Ahmed, {Omar Z.} and Gayane Yenokyan and Dylan Stewart and Burd, {Randall S.} and Ryan, {Leticia Manning}",
year = "2020",
month = "2",
day = "1",
doi = "10.1016/j.jss.2019.08.008",
language = "English (US)",
volume = "246",
pages = "153--159",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients

AU - Rubens, Jessica H.

AU - Ahmed, Omar Z.

AU - Yenokyan, Gayane

AU - Stewart, Dylan

AU - Burd, Randall S.

AU - Ryan, Leticia Manning

PY - 2020/2/1

Y1 - 2020/2/1

N2 - 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.

AB - 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.

KW - Pediatric trauma

KW - Self-transport

KW - Trauma activation

UR - http://www.scopus.com/inward/record.url?scp=85072762893&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072762893&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2019.08.008

DO - 10.1016/j.jss.2019.08.008

M3 - Article

C2 - 31586889

AN - SCOPUS:85072762893

VL - 246

SP - 153

EP - 159

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -