Predicting Outcomes after Pediatric Non-Accidental Trauma
Brett Tracy, M.D.; Krista Miller, M.D.; Eric Clayton, M.S.; Jo Cooke-Barber, M.D.; Kathryn Bailey, F.N.P.; William Boswell, M.D.
Memorial Health University Medical Center, Savannah, GA
BACKGROUND- Non-accident trauma (NAT) is a serious cause of pediatric injury. Determining the factors that result in favorable outcomes is essential in optimizing care for these youths.
METHODS- Our trauma center's registry was queried for NAT patients from January 2016 to April 2018. We collected demographic data, injury severity score (ISS), injuries, transfer status, and admission location. Outcomes included length of stay (LOS), mortality, and discharge to alternate caregiver status.
RESULTS- We isolated 30 NAT patients with a mean age of 2.37 (±4.7 SD) years, mean ISS 9 (±6.5 SD), and mean LOS 3.5 (±3 SD) days. Frequent injuries were intracranial hematomas and skull fractures. Forty percent went to the floor, 7% to the OR, 16% to the stepdown, and 37% to the ICU. Three patients died, 12 were discharged to alternate caregivers, and 15 returned home. Increasing age carried a shorter LOS (OR 0.941, CI 0.887-0.999, p=0.046). Transferred patients had shorter LOS (OR 0.56, CI 0.382-0.824, p=0.003) and patients triaged to the stepdown unit versus floor had shorter LOS (OR 0.392, CI 0.186-0.827, p=0.014). ICU admissions were associated with death (p=0.041). No variables predicted discharge to an alternate caregiver.
CONCLUSIONS- Older and transferred NATs are associated with shorter LOS, suggesting older age as a protective factor and questioning the rationale for inter-hospital transfer. The frequent care in the stepdown unit may contribute to a shorter hospitalization. Future research should investigate which factors result in discharge to an alternate caregiver to identify how to place children in safer environments.
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