Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research


(SDAS) Emergency Medical Care of Severely Injured US Children

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Project Number: R40MC29448
Grantee: The Research Institute at Nationwide Children's Hospital
Department/Center: Pediatrics Center for Injury Research
Project Date: 04/01/2016
Principal Investigator: Henry  Xiang

Final Report

Pending

Age

  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)

Abstract

In the United States, about 7,000 children die each year from unintentional injuries, and 7.4 million children are treated at emergency departments for nonfatal injuries. In the past 4 decades, regionalized trauma care has been promoted in the U.S. as the best approach for matching patient needs with the available resources and provider expertise to achieve optimal patient outcomes. Within an ideal organized trauma system, patients with severe injuries should receive definitive care at level I or II trauma centers (TCs) while those with minor injuries should receive care at nontrauma centers (NTCs) or level III trauma centers. In this proposed research, our target population is severely injured children (0-16 years old) treated in U.S. emergency departments. Level I and II trauma centers have been shown to provide survival benefits to severely injured children. Severely injured children are undertriaged if they are treated at nontrauma centers. However, the proportion of U.S. severely injured children who are undertriaged and the risk factors for undertriage of children remain unknown. Regional and small studies have also suggested that a significant proportion of injured U.S. children are treated at adult trauma centers, but no national data are available about pediatric trauma patients who are treated at adult centers. Furthermore, severely injured children initially seen at NTCs should be transferred to TCs to receive the optimal level of care. Interhospital transfer procedures, a key component of statewide trauma systems, are intended to ensure expeditious and seamless transfer of severely injured children to TCs. But no study has examined the effect of statewide trauma systems on interhospital transfer patterns among severely injured children initially seen at NTCs. The goal of our study is to use the existing Nationwide Emergency Department Sample (NEDS) and the State Emergency Department Databases (SEDD) to study the extent to which severely injured children needing specialized trauma care actually receive them. Our specific aims are: Aim 1) To estimate the rate of undertriage and the risk factors for being undertriaged among severely injured US children; Aim 2) To estimate the proportion of severely injured US children who received emergency care at adult trauma centers; and Aim 3) To study the effect of statewide trauma systems on interhospital transfer among severely injured children initially seen at NTCs. We will assess the impact of health insurance and urban-rural location of residence on the delivery of emergency care services to severely injured children. Our findings about undertriage patterns among severely injured children will have significant implications for improving trauma systems so as to reduce preventable mortality among severely injured children. Our findings about the proportion of severely injured children who are treated at adult trauma centers will have significant implications for developing policy and national efforts for promoting added qualifications for adult trauma centers to treat severely injured children. Understanding the patterns of interhospital transfer is essential when evaluating outcomes, especially for children in rural areas, where appropriate pediatric trauma care resources are not available. Our findings about interhospital trauma transfer will be significant for national and state efforts in advancing statewide trauma systems to ensure severely injured children receive optimal levels of trauma care. Ultimately, the proposed research will make significant contributions to our field, because it will provide important evidence for improving trauma systems that target severely injured children, promoting added qualifications for adult trauma centers to treat severely injured children, and advancing the development of statewide trauma systems to ensure severely injured children receive optimal levels of care. Our study addresses the Maternal and Child Health (MCH) Bureau's Strategic Research Issues #I "service systems and infrastructures at the community, state and national levels, as they apply to different MCH populations;" Strategic Research Issues #III "services and systems to assure quality of care." Our study belongs to the MCH Block Grant National Performance Priority Area #7: Injury among children and adolescent. Our study is also relevant to the Healthy People 2020 Objectives (IVP8): Increase Access to Trauma Care.

Publications

Listed is descending order by year published.

Chen C, Shi J, Stanley RM, Sribnick EA, Groner JI, Xiang H. U.S. Trends of ED Visits for Pediatric Traumatic Brain Injuries: Implications for Clinical Trials. Int J Environ Res Public Health. 2017 Apr 13;14(4). pii: E414.

Corrado MM, Shi J, Wheeler KK, Peng J, Kenney B, Johnson S, Xiang H. Emergency medical services (EMS) versus non-EMS transport among injured children in the United States. Am J Emerg Med. 2017 Mar;35(3):475-478.

Peng J, Wheeler K, Groner JI, Haley KJ, Xiang H. Undertriage of Pediatric Major Trauma Patients in the United States. Clin Pediatr (Phila). 2017 Aug;56(9):845-853.

Wheeler KK, Shi J, Nordin AB, Xiang H, Groner JI, Fabia R, Thakkar RK. U.S. Pediatric Burn Patient 30-Day Readmissions. J Burn Care Res. 2017 Aug 18.

Wheeler KK, Shi J, Xiang H, Haley KJ, Groner JI. Child maltreatment in U.S. emergency departments: Imaging and admissions. Child Abuse Negl. 2017 Jul;69:96-105.

Wheeler KK, Shi J, Xiang H, Thakkar RK, Groner JI. US pediatric trauma patient unplanned 30-day readmissions. J Pediatr Surg. 2017 Aug 7. pii:S0022-3468(17)30466-9.

Shi J, Lu B, Wheeler KK, Xiang H. Unmeasured Confounding in Observational Studies with Multiple Treatment Arms: Comparing Emergency Department Mortality of Severe Trauma Patients by Trauma Center Level. Epidemiology. 2016 Sep;27(5):624-32.

Keywords

Emergency Care, Trauma & Injury, Access to Health Care, Health Care Quality, Health Care Utilization, Health Disparities, Cost Effectiveness, Insurance Coverage, Social Determinants of Health

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