Robust pediatric trauma system may be associated with improved pediatric mortality
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Published results showed a more robust pediatric trauma system may have a significant association with improved pediatric mortality after traumatic injury.
“Potentially, sharing of resources among regional states may improve the care of pediatric trauma patients in that region,” the authors wrote.
In 2018, researchers asked four officials from each state to complete a national survey regarding extensive pediatric-related or specific trauma system parameters of state pediatric trauma system capabilities. A panel of 14 individuals representing national stakeholder sectors in pediatric trauma care used these parameters to identify the essential components of the ideal pediatric trauma system using Delphi methodology. Researchers gave each state a composite score based on results from the national survey and consensus panel parameters. Researchers validated the composite score using the U.S. CDC Wide-Ranging Online Data for Epidemiologic Research fatal injury database.
Results showed less than 10% of data were missing from the national survey. With regard to the domains of pediatric trauma systems, researchers found the consensus panel reached agreement on disaster, legislation/funding, access to care, injury prevention/recognition, quality improvement and pediatric readiness. These six domains were used to develop the Pediatric Trauma System Assessment Score (PTSAS) based on 100 points, according to researchers.
Researchers found substantial variation in the PTSAS across states, ranging from the lowest score of 48.5 to the highest score of 100. Linear regression showed there was a 0.12 per 100,000 decrease in mortality for every one-point increase in the PTSAS, with an association between increasing scores and a significant decrease in both in-hospital and out-of-hospital pediatric mortality.
“This study can inform the integration of pediatric trauma parameters and scoring into the next version of the [American College of Surgeons] ACS trauma system scoring tool, emphasizing incremental change and progress over time,” the authors wrote. “The current PTSAS is a starting point and can be modified over time but is a step toward assessing each state’s pediatric trauma care capabilities within defined regions of the country.”
Perspective
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Jeffrey R. Sawyer, MD
Considerable variability exists in resources available for pediatric trauma care in the United States. The authors have developed a methodology to quantitatively evaluate state pediatric trauma systems: the PTSAS. They should be commended for the amount of time and effort it took with data collection/analysis and Delphi methodology.
The finding that considerable variability exists between states in terms of their outcome score is not surprising. They also highlighted the variability, and some of the lowest compliance on the PTSAS is individual state support of legislation/funding of pediatric trauma systems. Using the PTSAS, they were able to show an inverse correlation between a state’s PTSAS score and pediatric trauma-related mortality.
There are limitations to this study. Many are inherent to population database studies including incomplete/incorrect data reporting, changes within individual state trauma systems during the study period and potential biases involved in selecting Delphi committee participants. Mortality, as recognized by the authors, is not the best outcome measure for pediatric trauma patients. It should be noted that PTSAS scores are state-specific. These are not trauma center-specific as 16% of PTSAS scoring is based on legislation/funding, which is completely out of the control of any individual trauma center.
Despite these limitations, this paper provides a methodology to objectively measure pediatric trauma system preparedness, which should be included in the next American College of Surgeons scoring tool for trauma centers.
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