A Four-Year Experience at a Level I Pediatric Trauma Center: 2009-2012
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BACKGROUND: In the United States, trauma is the leading cause of death and disability in children. Annually 140,000 children are seen in the Emergency Department(ED) at our single Level-I verified pediatric trauma center. 12,000 -13,000 are due to trauma, with approximately 1,400 admissions. We reviewed the trauma experience at our hospital to assess its impact based upon the management, outcome, and hospital charges for these patients. METHODS: With IRB approval, the hospital Trauma Registry was accessed to identify the severity of injury, management and outcomes for patients admitted from Jan. 2009 - Dec. 2012. Data points included age, gender, Trauma Activation (TA), Injury Severity Score (ISS), admit service, ICU admission, length of stay (LOS), operative need, mortality, and hospital charges. ED deaths were excluded. RESULTS: There were 5,514 trauma admissions, 8.18% of all of the 67,429 hospital admissions; 60% were boys and 40% girls. Age was 6.82±4.41 years, and ISS was 8.21±7.54. 54% had a minor ISS (0-7), 32% moderate (8-15), 9.5% severe (16-24), and 5.2% very severe (>24). TAs were called in 1346(24.4%) patients, 1014(75.3%) ALERTs and 332(24.7%) STATs. 2607 (47.3%) patients required an operation. The majority of patients were assigned to Pediatric Surgery (44%) and Orthopedic Surgery (41%). Trauma ICU admissions were 14.2% of all trauma admissions, comparable to all hospital ICU admissions at 17.4%. The trauma ICU LOS was 3.59±5.64 days; this doubled to 7.02±15.96 days for all hospital ICU admissions. The trauma LOS was 2.48±4.57 days; again, this doubled to 5.17±10.31 days for all hospital patients. There were 64 trauma deaths (1.16%). The trauma cohort accounted for $188,472,675 of hospital charges, which was 4.3% of all hospital charges ($4,375,099,917) for four years. The average charge per trauma patient was $36,746 vs. $65,324 for all admits. CONCLUSION: If trauma were a single disease, it would be the third most frequent admission diagnosis. The trauma population is heterogeneous; 24% of the trauma patients required TA, 14% ICU admission, 47% needed surgery, and 46% had a moderate or higher ISS. The mortality rate of 1.16% is less than the national average of 2.26%. Hospital charges and the LOS (total and ICU) for trauma patients were half that of all patients. The lower cost may be due to an efficient use of resources, management, and care of trauma patients. Our patient management and hospital charges for these trauma patients, coupled with good outcomes, may be a model for other hospital admissions and other trauma programs.