Does pediatric trauma center designation matter for children in shock from gunshot wounds? A Trauma Quality Improvement Program analysis.

IF 2.9 2区医学 Q2 CRITICAL CARE MEDICINE

Journal of Trauma and Acute Care Surgery Pub Date : 2025-06-10 DOI:10.1097/TA.0000000000004637

Micaela K Gomez, Elizabeth C Wood, Maximilian Peter Forssten, Timothy K Williams, Sebastian Peter Forssten, Babak Sarani, Shahin Mohseni, Lucas P Neff

{"title":"Does pediatric trauma center designation matter for children in shock from gunshot wounds? A Trauma Quality Improvement Program analysis.","authors":"Micaela K Gomez, Elizabeth C Wood, Maximilian Peter Forssten, Timothy K Williams, Sebastian Peter Forssten, Babak Sarani, Shahin Mohseni, Lucas P Neff","doi":"10.1097/TA.0000000000004637","DOIUrl":null,"url":null,"abstract":"Background: Recent studies have demonstrated improved outcomes for severely injured pediatric trauma patients treated at pediatric trauma centers (PTCs). Nonetheless, specific injury patterns requiring immediate lifesaving intervention may offset the recognized benefits of PTC over adult trauma centers (ATCs). This study aims to compare the clinical outcomes of hypotensive pediatric trauma patients with gunshot wounds (GSWs), based on trauma center type. We hypothesize that outcomes are equivalent for this clinical scenario.Methods: The 2013-2021 Trauma Quality Improvement Program data set was used to identify all hypotensive pediatric patients (15 years or younger) with GSWs. Hypotension was defined per Pediatric Advanced Life Support Guidelines. Patients with an Abbreviated Injury Scale score of 6 in any region and transferred patients were excluded. In order to identify the association between PTC verification status and outcomes, Poisson regression models with robust standard errors were used.Results: A total of 687 patients met the criteria for analysis, and 236 (34%) cases were treated at PTCs. Pediatric trauma center patients were slightly younger (lower quartile, 10 vs. 12 years old; p = 0.037). There was no significant difference in Injury Severity Score or crude mortality rates (68.1% vs. 70.8%, p = 0.524). After adjusting for confounders, Poisson regression showed no reduction in in-hospital mortality, complications, failure to rescue, intensive care unit admission, or mechanical ventilation rates at PTCs compared with ATCs.Conclusion: Gunshot wounds in children pose unique clinical challenges. Majority of cases are cared for at ATCs. Analysis of best available data did not demonstrate a benefit to managing these patients at a PTC. Conversely, ATCs were not superior, despite managing this scenario in both adults and children more often. These findings underscore the importance of ATCs in the care of this particular injury pattern and call attention to the recent pediatric readiness requirements for American College of Surgeons (ACS)-verified trauma centers to treat pediatric firearm injuries at both PTCs and ATC.Level of evidence: Therapeutic/Care Management; Level III.","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Trauma and Acute Care Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TA.0000000000004637","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Recent studies have demonstrated improved outcomes for severely injured pediatric trauma patients treated at pediatric trauma centers (PTCs). Nonetheless, specific injury patterns requiring immediate lifesaving intervention may offset the recognized benefits of PTC over adult trauma centers (ATCs). This study aims to compare the clinical outcomes of hypotensive pediatric trauma patients with gunshot wounds (GSWs), based on trauma center type. We hypothesize that outcomes are equivalent for this clinical scenario.

Methods: The 2013-2021 Trauma Quality Improvement Program data set was used to identify all hypotensive pediatric patients (15 years or younger) with GSWs. Hypotension was defined per Pediatric Advanced Life Support Guidelines. Patients with an Abbreviated Injury Scale score of 6 in any region and transferred patients were excluded. In order to identify the association between PTC verification status and outcomes, Poisson regression models with robust standard errors were used.

Results: A total of 687 patients met the criteria for analysis, and 236 (34%) cases were treated at PTCs. Pediatric trauma center patients were slightly younger (lower quartile, 10 vs. 12 years old; p = 0.037). There was no significant difference in Injury Severity Score or crude mortality rates (68.1% vs. 70.8%, p = 0.524). After adjusting for confounders, Poisson regression showed no reduction in in-hospital mortality, complications, failure to rescue, intensive care unit admission, or mechanical ventilation rates at PTCs compared with ATCs.

Conclusion: Gunshot wounds in children pose unique clinical challenges. Majority of cases are cared for at ATCs. Analysis of best available data did not demonstrate a benefit to managing these patients at a PTC. Conversely, ATCs were not superior, despite managing this scenario in both adults and children more often. These findings underscore the importance of ATCs in the care of this particular injury pattern and call attention to the recent pediatric readiness requirements for American College of Surgeons (ACS)-verified trauma centers to treat pediatric firearm injuries at both PTCs and ATC.

Level of evidence: Therapeutic/Care Management; Level III.

查看原文本刊更多论文

小儿创伤中心的指定对枪伤休克的儿童有影响吗？创伤质量改善计划分析。

背景：最近的研究表明，在儿科创伤中心（ptc）治疗的严重创伤儿童患者的预后有所改善。尽管如此，特殊的损伤模式需要立即挽救生命的干预可能抵消了PTC比成人创伤中心（ATCs）公认的好处。本研究旨在比较枪伤（GSWs）低血压儿童创伤患者的临床结果，基于创伤中心类型。我们假设这种临床情况的结果是相同的。方法：使用2013-2021年创伤质量改善计划数据集来识别所有伴有GSWs的低血压儿童患者（15岁或以下）。低血压是根据儿科高级生命支持指南定义的。排除任何地区简略损伤量表评分为6分的患者和转院患者。为了确定PTC验证状态与结果之间的关联，使用了具有鲁棒标准误差的泊松回归模型。结果：687例患者符合分析标准，其中236例（34%）在ptc治疗。儿童创伤中心的患者年龄略小(下四分位数，10岁vs. 12岁；P = 0.037)。损伤严重程度评分和粗死亡率无显著差异（68.1%比70.8%,p = 0.524）。调整混杂因素后，泊松回归显示，与ATCs相比，ptc的住院死亡率、并发症、抢救失败、重症监护病房入院率或机械通气率均未降低。结论：儿童枪伤具有独特的临床挑战。大多数病例在空中交通管制中心得到治疗。对现有最佳数据的分析并没有证明在PTC管理这些患者有好处。相反，ATCs并不优越，尽管在成人和儿童中更经常处理这种情况。这些发现强调了ATC在治疗这种特殊伤害模式中的重要性，并引起了人们对美国外科医师学会（ACS）认证的创伤中心在PTCs和ATC治疗儿童火器伤害的最新儿科准备要求的关注。证据水平：治疗/护理管理；第三层次。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.