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Outcomes of Pediatric Trauma Patients Admitted to a Surgical vs. General Pediatric Service
Bryanna Emr, MD, Jennifer Stanger, MD and Tamer Ahmed, MD, SUNY Upstate Medical University, New York NY

Abstract: Purpose: According to ACS guidelines, pediatric trauma patients must be admitted to a surgical service. The quality of trauma care delivered by pediatrics compared with surgical teams is unknown. We hypothesize that children admitted to pediatric surgical services have improved outcomes. Methods: A retrospective review was performed on pediatric trauma admissions from 2007 – 2015 at a Level 1 trauma center ages 0-18. Patients were divided into groups by admission to pediatrics or surgery and stratified by injury severity score (ISS). Results: 409 children were admitted to pediatrics and 2,933 children were admitted to pediatric surgery. Children admitted to pediatrics had similar lengths of stay compared to surgery except for ISS 26-30 (Table 1). ED length of stay was shorter for surgery with ISS 1-10 (Pediatrics 5.71±0.19 vs Surgery 4.85±0.09 hours, p=0.001). Number of CT/MRI scans was also decreased for surgery with ISS 1-10 (Pediatrics 1.24±0.04 vs Surgery 0.67±0.02, p<0.001). Overall, more children admitted to surgery were discharged to home (Pediatrics 86.4% vs Surgery 91.6%, p<0.001). Conclusion: According to our review of a single center experience, surgical and pediatric services had similar lengths of stay. However, number of radiology studies, ED length of stay, and disposition were improved by pediatric surgical admission. As pediatric trauma centers grow, outcomes may be improved by admission to pediatric surgical services.

Figures: Table 1. Length of Stay Pediatrics vs Surgery Admissions by Injury Severity Score. LOS=length of stay in days, ISS=injury severity score, SE=standard error.

 

 

Pediatrics

Surgery

 

ISS

Avg LOS (days)

N

SE

Avg LOS (days)

N

SE

p-value

1-5

1.79

175

0.12

1.77

1431

0.05

0.88

6-10

2.12

146

0.20

2.80

858

0.15

0.06

11-15

3.67

15

1.05

3.35

193

0.17

0.64

16-20

4.02

45

0.44

4.59

230

0.39

0.54

21-25

5.20

15

1.16

5.86

92

0.63

0.69

26-30

17.86

7

3.14

7.13

55

1.07

0.001**

 

Objective: At the end of this activity, the learner will be able to discuss the advantages of surgery admission after trauma.

Objective Content: Retrospective review of outcomes for pediatrics and surgery admissions after trauma.


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