Computed Tomography for Pediatric Pelvic Fractures in Pediatric Versus Adult Trauma Centers.
Adolescent
Child
Child, Preschool
Female
Fractures, Bone
/ complications
Hospitals, Pediatric
/ statistics & numerical data
Humans
Infant
Injury Severity Score
Male
Pelvic Bones
/ diagnostic imaging
Registries
/ statistics & numerical data
Retrospective Studies
Tomography, X-Ray Computed
/ adverse effects
Trauma Centers
/ statistics & numerical data
Treatment Outcome
United States
Computed tomography
Designation
Fracture
Level
Pediatrics
Pelvic
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
07
07
2020
revised:
08
10
2020
accepted:
02
11
2020
pubmed:
7
12
2020
medline:
11
5
2021
entrez:
6
12
2020
Statut:
ppublish
Résumé
Pediatric pelvic fractures are a significant source of morbidity for children in the United States. In the era of specialized care, the relationship between trauma center designation and outcomes remains unknown. We hypothesized that there would be no difference in patient outcomes when treated at adult trauma centers (ATCs), pediatric trauma centers (PTCs), or dual trauma centers (DTCs). We used the National Trauma Data Bank to identify pediatric (≤14 y) patients suffering pelvic fractures in 2013-2015. DTCs were defined as centers with level I or II trauma designation for both pediatric and adult care. Primary outcomes included mortality, complications, and computed tomography (CT) utilization. There were 4260 patients who met study criteria. Of these, 1290 (22%) were treated at ATCs, 1332 (30%) at PTCs, and 2120 (48%) at DTCs. Pediatric patients treated at ATCs were more likely to suffer a complication or receive a CT scan. On multivariate analysis, patients treated at PTCs and DTCs were significantly less likely to have a recorded complication or receive head, thoracic, or whole-body CT scans compared with ATCs. DTCs, but not PTCs, used fewer abdominal CT scans. Mortality rates were not predicted by center designation. For pediatric pelvic fractures, centers with pediatric trauma designation (PTCs and DTCs) appear to have better outcomes despite significantly less use of CT scans. Further studies are needed to determine optimal management of pediatric pelvic fractures while minimizing exposure to ionizing radiation. Level III Retrospective.
Sections du résumé
BACKGROUND
Pediatric pelvic fractures are a significant source of morbidity for children in the United States. In the era of specialized care, the relationship between trauma center designation and outcomes remains unknown. We hypothesized that there would be no difference in patient outcomes when treated at adult trauma centers (ATCs), pediatric trauma centers (PTCs), or dual trauma centers (DTCs).
MATERIALS AND METHODS
We used the National Trauma Data Bank to identify pediatric (≤14 y) patients suffering pelvic fractures in 2013-2015. DTCs were defined as centers with level I or II trauma designation for both pediatric and adult care. Primary outcomes included mortality, complications, and computed tomography (CT) utilization.
RESULTS
There were 4260 patients who met study criteria. Of these, 1290 (22%) were treated at ATCs, 1332 (30%) at PTCs, and 2120 (48%) at DTCs. Pediatric patients treated at ATCs were more likely to suffer a complication or receive a CT scan. On multivariate analysis, patients treated at PTCs and DTCs were significantly less likely to have a recorded complication or receive head, thoracic, or whole-body CT scans compared with ATCs. DTCs, but not PTCs, used fewer abdominal CT scans. Mortality rates were not predicted by center designation.
CONCLUSIONS
For pediatric pelvic fractures, centers with pediatric trauma designation (PTCs and DTCs) appear to have better outcomes despite significantly less use of CT scans. Further studies are needed to determine optimal management of pediatric pelvic fractures while minimizing exposure to ionizing radiation.
LEVEL OF EVIDENCE
Level III Retrospective.
Identifiants
pubmed: 33279844
pii: S0022-4804(20)30753-8
doi: 10.1016/j.jss.2020.11.015
pii:
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
47-54Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.