Time From Injury To Pediatric Trauma Center Arrival In Rhode Island: A Baseline Study Prior To Change In Ems Transport Time Protocol.
*Hale Wills, Ella Satish, Andrew McCarthy
Brown University, Providence, RI
Background:In 2017, our state EMS transport protocol changed the cut-off time for direct scene transport of severely injured children to a Pediatric Trauma Center (PTC) from 30 to 45 minutes. This study was conducted to establish baseline injury-to-PTC times, outcomes for scene (SA) versus transfer (TR), and proportions of TR/total prior to the change. Methods:Patients 0-17 y/o admitted with ISS ≥15 from 01/01/2005-12/31/2016 were identified in the trauma registry, and charts abstracted for injury time, injury zip code, ISS, ICU length-of-stay and, hospital disposition. SA and TR were compared using two-sample t-tests and Chi-Square. Findings:Of 5368 admitted traumas, 525 had ISS ≥15 with 153 (29%) TR. Of 490 with injury time recorded (SA 381, TR 109), injury-to-PTC for SA was 52 minutes vs. TR 3 hours 45 minutes, (p<0.05). Mean ISS for TR was 22, ICU LOS was 6.7 days, and mortality was 6.6%. Injury zip code was analyzed by heat map showing most severe pediatric injury occurs close to the PTC. Conclusions:Prior to the change in EMS cutoff, 29% of severely injured children arrived at the PTC by transfer, higher than the population distribution would predict. TR patients experience a mean of 177 minutes excess time to PTC arrival, with only 30-45 minutes of excess time accounted to ground transport time, yet have very high ISS, ICU utilization, and mortality. Impact of the change in transport cut-off time warrants further study.
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