S. M. Farach1, P. D. Danielson1, E. Amankwah2, N. M. Chandler1 1All Children’s Hospital Johns Hopkins Medicine,Pediatric Surgery,Saint Petersburg, FLORIDA, USA 2All Children’s Hospital Johns Hopkins Medicine,Clinical And Translational Research Organization,Saint Petersburg, FLORIDA, USA
Introduction: Pediatric trauma patients presenting with stable, isolated injuries are often admitted to the trauma service for initial management. The purpose of this study was to evaluate admission patterns in trauma patients with isolated injuries and to compare outcomes based on admitting service.
Methods: After Institutional Review Board approval, the institutional trauma registry was retrospectively reviewed for patients presenting from January 2007 to December 2012. A total of 3417 patients were admitted to a surgical service and were further reviewed. Patients were grouped by isolated or non-isolated injuries and further stratified into trauma service (TS) versus non-trauma service (NTS) admission. Significance was defined as p ≤ 0.05.
Results: Table 1 describes select demographic and outcomes data between the groups. Patients with isolated injuries admitted to a NTS were significantly younger, were more likely to present with Injury Severity Scores (ISS) ranging from 9-14, Glasgow Coma Scale (GCS) ≥ 13, had a shorter emergency room length of stay, were more likely to undergo surgery within 24 hours, and had significantly fewer computed tomography scans performed. Patients with isolated injuries admitted to the TS had a significantly lower GCS (3-12), were more likely to present with ISS ranging from 1-8, had longer emergency room length of stay, and were less likely to undergo surgery within 24 hours. There was no significant difference between the groups for ISS ≥ 15. Patients with isolated injuries following falls or sports related injuries were more likely to be admitted to NTS, while those presenting after motorized trauma were more likely to be admitted to the TS. Patients with isolated injuries admitted to NTS included: 54.4% orthopedic, 38.3% neurosurgery, and 7.3% other. There were no missed injuries noted in patients with isolated injuries admitted to NTS with 5% having a TS consult. Patients with isolated injuries admitted to a NTS were found to have significantly lower complication rates.
Conclusion: Pediatric trauma patients presenting with stable, isolated injuries may be efficiently and safety managed by non-trauma services without an increase in missed injuries or complications.
