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Mailing address:
Yale-New Haven
Children's Hospital
20 York Street
New Haven, CT
06510-3202
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Decemmber 2006
News this month A study published in the January 2006 Journal of Pediatric Surgery by researchers at the Medical College of Wisconsin in Milwaukee and Children’s Research Institute concludes that the risk of death for injured children is significantly lower when care is provided in pediatric trauma centers than in non-pediatric centers. After analyzing nearly 80,000 pediatric trauma cases, researchers revealed that nearly 90 percent of injured children nationally were treated at adult hospitals or in children’s units at adult hospitals. The remaining 11 percent of the patients who were treated at children’s hospitals had significantly lower mortality rates, lengths of stay and hospital bills. "The risk of death for injured
children is significantly
lower when care is provided
in pediatric trauma centers
than in non-pediatric
centers."
Mortality rates were lowest (0.9 percent) in children’s hospitals, as compared to 1.4 percent in adult hospitals. The mortality rates were highest (2.4 percent) in children’s units within adult hospitals. The number of days that patients stayed in the hospital was shortest at children’s hospitals, longer in adult hospitals and longest in children’s units within adult hospitals. In 2002, the most recent year for which data is available, there were 18,953 injury-related deaths among children age 1 to 20 years. The study’s data indicates that the majority of the youngest and most severely injured children received care in hospitals with poorer outcomes. “The geographic disparity and limited number of pediatric surgeons, specialists and children’s hospitals have been cited as the reason for problems in current pediatric trauma care,” said Keith T. Oldham, MD, professor and chief of surgery at Children’s Hospital in Wisconsin and co-author of the study. “We hope this study helps people understand the need for pediatric-specific trauma care throughout the United States.” Although the majority of children who need emergency medical care are brought to hospitals that have appropriate emergency-care specialists and equipment, a significant number are treated at facilities that lack the recommended pediatric equipment and a fully-trained pediatric staff, according to a new report from the Centers for Disease Control and Prevention (CDC). The survey, conducted in 2002 and 2003, found the vast majority of children who need emergency care are brought to hospitals that see more than 10,000 pediatric patients each year. The survey found that these larger hospitals are more likely to have a pediatric ward, a pediatric intensive care unit and are also more likely to have a board-certified pediatric emergency physician on staff. “We are pleased to find that the hospitals that see the majority of these young patients are the best prepared, but we also believe other hospitals would benefit from strengthening their capacity,” said Kimberly Middleton, a health scientist at CDC’s National Center for Health Statistics and lead author of the study. The American Academy of Pediatrics and the American College of Emergency Physicians set new pediatric emergency guidelines in 2001 calling for more pediatric services and medical expertise, as well as supplies and equipment that are appropriately sized for children. The guidelines followed a 1998 study of hospital emergency services for children conducted by the Consumer Product Safety Commission, which found that emergency and critical care of infants and children varied widely in different regions of the country and by different types of hospitals.
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 Level I pediatric trauma center designation recognizes expertise in managing any acute injury to a child This research underscores the importance of having standards of care that are geared to the special needs of injured children, as we have here at Yale-New Haven Children’s Hospital, the only verified pediatric level I trauma center in Connecticut. "Children account for about
30 million visits a year to
hospital emergency
departments."
To be designated a pediatric trauma center, a hospital must undergo an onsite review by a team of experienced trauma surgeons. This accreditation recognizes the expertise in managing any acute injury to a child, ranging from routine fractures to lifethreatening traumatic injuries. We also meet all stringent standards for trauma care, research and education, as required by the American College of Surgeons (ACS), the organization responsible for trauma center verification. A level I trauma center also provides leadership in prevention, public education and continuing education of its trauma team and conducts research to develop innovations in trauma care. Trauma is defined as a severe injury that may cause death or significant disability. Common causes of trauma include car accidents, falls, burns, knife and gunshot wounds, and sport or recreational injuries. Trauma is the leading cause of death for persons age 1 through 34. Children account for about 30 million visits a year to hospital emergency departments. A trauma center’s success depends on its ability to execute a multidisciplinary team approach to the care of injured children. A Level I pediatric trauma center includes full-time availability of pediatric surgeons, pediatric neurosurgeons, pediatric orthopedic surgeons, pediatric emergency physicians, pediatric anesthesiologists and pediatric critical care specialists. Children are physically, psychologically and physiologically different from adults, so emergency care providers are trained not only to recognize the different ways that children’s bodies respond to traumatic injury and illnesses, but also to communicate and comfort young patients effectively. "A trauma center’s success
depends on its ability to
execute a multidisciplinary
team approach to the care
of injured children."
A designated level I trauma center means that the hospital is equipped to handle the most serious types of trauma cases for adults and children and can perform surgery on critically ill patients immediately. Often, of course, parents don’t have a choice of emergency rooms, especially in rural areas. But parents can do some homework on which hospitals in a community are best equipped to handle pediatric patients. Hospital Web sites often provide detailed information about their pediatric emergency facilities. As an ACS-verified Level I pediatric trauma center, the team at Yale-New Haven Children’s Hospital is dedicated to providing state-of-the-art care to critically ill and injured patients. As underscored by the researchers at the Medical College of Wisconsin in Milwaukee and Children’s Research Institute Children’s Hospital in Wisconsin, pediatric patients are not to be viewed or treated as ‘little adults,’ but rather patients who require ageappropriate equipment and expertise. The importance of a cohesive, multidisciplinary team, composed of pediatric surgeons, pediatric orthopedics and pediatric neurosurgeons, all available to the pediatric emergency room at YNHH, 24 hours a day and 365 days a year cannot be underestimated. Kimberly A. Davis, MD, is the director of trauma services at Yale-New Haven Hospital and is an associate professor of surgery, and the chief of the section of trauma, surgical critical care and surgical emergencies at the Yale School of Medicine. |
