Trauma Routing Algorithm for Pediatrics
Condition: Pediatric All; Trauma
MeSH terms: Wounds and Injuries
Study type: Observational [Patient Registry]

Summary: 
      Traumatic injury is the leading cause of pediatric death in the United States for those
      forty-four years of age and younger. Pediatric trauma patients generally have reduced
      mortality when treated at pediatric trauma centers rather than at adult centers or
      non-tertiary care facilities. However, nearly half the US pediatric population lives over
      fifty miles from a Level I or II Trauma Center. While air ambulances are readily available in
      many jurisdictions, few guidelines and little evidence dictate their appropriate use,
      especially with regard to pediatric trauma. Previous research is mixed regarding mortality
      benefit from helicopter Emergency Medical Services (EMS) in injured children. Previous
      attempts to develop appropriate field triage criteria have failed due to poor sensitivity and
      specificity for identifying the critically injured child. The current high rate of overtriage
      is particularly concerning in today's cost-conscious medical community. This research study
      aims to categorize pre-hospital pediatric trauma in North Carolina, to determine what
      benefits helicopter EMS provides in the North Carolina trauma system, and to formulate an
      enhanced screening tool for pre-hospital use to help determine which patients are suitable
      candidates for helicopter EMS transport.
    

Detailed description: 
      The North Carolina Trauma Registry will identify pediatric trauma patients between 0 and 18
      years of age who presented directly to North Carolina Level 1 Trauma Centers from the field
      after sustaining injury from January 1st, 2013 and October 2017.

      The analysis will be a retrospective cohort study by nature of the data set. Final
      methodology will be determined after Institutional Review Board approval and enlistment of
      statistical support through the Clinical and Translational Science Institute. Clinical and
      non-clinical factors will first be summarized with univariate analysis to provide a
      descriptive overview of the study population. These factors will include number of
      case-patients, demographics, scene address/location, time of injury, EMS agency involved, EMS
      call times, transport mechanism, time of transport, distance of transport, geographic area of
      injury, mechanism of injury, severity scores, Glasgow Coma Score, vital signs, receiving
      hospital name, and other variables. Similarly, interventions and outcomes will be compared
      between study groups through such factors such as length of emergency department stay,
      emergency department disposition, time to operating room, intubation status on arrival,
      administration of blood products, days of hospital stay, days of intensive care unit stay,
      days on ventilator, if viable organs were procured post-mortem, and mortality at given time
      points. Outcomes will be compared through regression analysis or related means.
    

Observational model: Cohort
Time perspective: Other
Sampling method: Probability Sample
Study population: 
        Patients <16 years old involved in trauma that were transported to a North Carolina Trauma
        Center
      
Keywords: prehospital; aeromedical; trauma; ems; helicopter