Pediatric trauma center criteria: an outcomes analysis.

Background/purpose: Trauma centers (TC) are certified based on widely accepted criteria. These specific criteria rarely are scrutinized individually. The purpose of this study was to analyze the individual components of a pediatric trauma center for their effect on outcome.
Methods: Members of the National Pediatric Trauma Registry were queried about the following: (1) separate pediatric emergency department (ED), (2) pediatric intensive care unit (PICU), (3) pediatric intensivist as PICU director, (4) pediatric surgeon as TC director, (5) in-house attending surgeon, (6) in-house pediatric emergency physician, (7) 24-hour operating room, (8) 24-hour computed tomography (CT) scan. Outcomes analyzed included mortality, length of stay, time in ED, days in PICU, and disability. Victims were stratified based on age (<7 or > or = 7 years) and severity of injury (ISS < or = 16, 17-35, > or = 36). Results were compared using Student's t test and chi2 analysis.
Results: A total of 59 of 74 centers responded, 18 were dropped because of low enrollment (mean, 1.6 patients). Questions 3, 4, 6, and 7 were eliminated because of skewed data. An in-house surgeon reduced the amount of time a mildly injured patient (ISS < or = 16) spent in the ED (210 v434 minutes), as did the separate pediatric ED (333 v592 minutes) and pediatric emergency physicians (344 v 507 minutes) in younger patients (> or = 7 years). An in-house surgeon reduced the morality rate in older (> or = 7) severely injured (ISS > or = 36) patients (46.7% v 56.8%; P < .05 for all). No other differences were significant.
Conclusions: In-house personnel improved efficiency for the less severely injured, and an in-house attending surgeon reduced mortality in the severely injured older patient. None of the other variables were found to have a significant impact on outcome.