Preview

Current Pediatrics

Advanced search

Quality of Emergency Hospital Care for Children with Severe Mechanical Traumas in Pediatric and Non-Pediatric In-Patient Hospitals: Results of the Retrospective Cohort Study

https://doi.org/10.15690/vsp.v15i4.1589

Abstract

Background: Comparability of the quality of medical care for children in different types of in-patient hospitals remains a subject of debate.

Objective: Our aim was to compare the quality of emergency hospital care for children with severe traumas in pediatric and non-pediatric in-patient hospitals.

Methods: Retrospective cohort (continuous) research. We analyzed medical records of intensive care patients (form 003/u) with severe traumas at the age of 1 month to 18 years hospitalized to in-patient hospitals of Rostov Oblast in 2010–2014. The quality of medical care was assessed according to duration of diagnostic maneuvers that led to the diagnosis and surgical activity (frequency of surgical interventions for the condition that led to hospitalization).

Results: We analyzed the data on 134 children with severe mechanical traumas hospitalized to pediatric (n = 29) and non-pediatric (n = 105) in-patient hospitals. Lifethreatening traumas (Pediatric Trauma Score 8 points) were recorded in 26 (90%) and 79 (75%) children, respectively (p = 0.127). The duration of the diagnosis stage in two groups was 135 (120; 160) and 140 (110, 210) minutes, respectively (p = 0.548). Surgical activity was higher in pediatric in-patient hospitals: surgical interventions were performed in 16 (55%) children compared to 37 (35%) cases in the group of children admitted to non-pediatric hospitals (p = 0.052).

Conclusion: The quality of emergency in-patient hospital care for children with severe traumas in pediatric and non-pediatric hospitals does not differ significantly.

About the Authors

Alexey V. Chernozubenko
Regional Children's Clinical Hospital, Rostov-on-Don, Russian Federation
Russian Federation


Dmitry V. Prometnoy
Regional Children's Clinical Hospital, Rostov-on-Don, Russian Federation Rostov State Medical University, Rostov-on-Don, Russian Federation
Russian Federation


Fedor G. Sharshov
Regional Children's Clinical Hospital, Rostov-on-Don, Russian Federation Rostov State Medical University, Rostov-on-Don, Russian Federation
Russian Federation


Galina A. Prometnaya
Regional Children's Clinical Hospital, Rostov-on-Don, Russian Federation
Russian Federation


References

1. Прометной Д.В., Спиридонова Е.А., Румянцев С.А. и др. Смерт ность детского населения в Ростовской области // Эпиде мио логия и инфекционные болезни. Актуальные вопросы. — 2014. — № 6. — С. 63–68. [Prometnoy DV, Spiridonova EA, Rumyantsev SA, et al. Child mortality in the Rostov Region. Epidemiol Infekc Bolezni. 2014; (6):63–68. (In Russ).]

2. Tasker RC, Fleming TJ, Young AE, et al. Severe head injury in children: intensive care unit activity and mortality in England and Wales. Br J Neurosurg. 2011;25(1):68–77. doi: 10.3109/02688697.2010.538770.

3. Odetola FO, Mann NC, Hansen KW, Bratton SL. Factors Associated with Time to Arrival at a Regional Pediatric Trauma Center. Prehosp Disaster Med. 2016;31(1):4–9. doi: 10.1017/ S1049023X15005191.

4. Валеев З.Г., Беляков В.Г., Саляхова Л.Я. Оценка госпитального этапа оказания скорой медицинской помощи больным при досуточной летальности // Казанский медицинский журнал. — 2013. — Т.94. — №1. — С. 111–114. [Valeev ZG, Belyakov VG, Salyakhova LYa. Analysis of in-hospital stage of emergency medical care and 24-hour mortality in emergency patients. Kazan Med Zh. 2013;94(1):111–114. (In Russ).]

5. aap.confex.com [Internet]. Reed CR, Hamill ME, Safford SD. Hospital resource utilization, mortality, and insurance status among pediatric trauma patients [cited 2016 Jun 12]. Available from: https://aap.confex.com/aap/2015/webprogrampress/ Paper31579.html.

6. Falcone RA, Jr., Milliken WJ, Bensard DD, et al. A paradigm for achieving successful pediatric trauma verification in the absence of pediatric surgical specialists while ensuring quality of care. J Trauma Acute Care Surg. 2016;80(3):433–439. doi: 10.1097/ TA.0000000000000945.

7. Demetriades D, Martin M, Salim A, et al. The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg. 2005;242(4):512–517. doi: 10.1097/01.sla.0000184169.73614.09.

8. Александрович Ю.С., Гордеев В.И. Оценочные и прогностические шкалы в медицине критических состояний. — СПб.: Сотис; 2007. — 140 с. [Aleksandrovich YuS, Gordeev VI. Otsenochnye i prognosticheskie shkaly v meditsine kriticheskikh sostoyanii. St. Petersburg: Sotis; 2007. 140 p. (In Russ).]

9. Larsen GY, Schober M, Fabio A, et al. Structure, process, and culture differences of pediatric trauma centers participating in an international comparative effectiveness study of children with severe traumatic brain injury. Neurocrit Care. 2015;24(3):353–360. doi: 10.1007/s12028-015-0218-6.

10. Miyata S, Haltmeier T, Inaba K, et al. Should all severely injured pediatric patients be treated at pediatric level I trauma centers?A national trauma data bank study. Am Surg. 2015;81(10):927–931.

11. Павленко В.Л., Шаршов Ф.Г., Спиридонова Е.А. и др. Система контроля качества оказания медицинской помощи детям с тяжелой травмой на территории Ростовской области // Анестезиология и реаниматология. — 2010. — № 1. — С. 47–49. [Pavlenko VL, Sharshov FG, Spiridonova YeA, et al. Medical care quality control system for children with severe injury in the Rostov Region. Anesteziol Reanimatol. 2010;(1):47–49. (In Russ).]

12. Бабич И.И., Выгонская Т.В., Шаршов Ф.Г. и др. Организация медицинской помощи детям с травмой в результате ДТП на территории Ростовской области // Общая реаниматология. — 2009. — Т. V. — № 5. — С. 31–36. [Babich II, Vygonskaya TV, Sharshov FG, et al. Organization of medical care to children with road traffic injury in the Rostov Region. Obshchaya reanimatologiya. 2009;5(5):31–36. (In Russ).]

13. Шаршов Ф.Г., Спиридонова Е.А., Румянцев С.А. и др. Двухуровневая система контроля качества оказания медицинской помощи детям с тяжелой травмой на территории Ростовской области // Практическая медицина. — 2009. — № 8. — С. 94– 95. [Sharshov FG, Spiridonova EA, Rumyantsev SA, et al. Dvukhurovnevaya sistema kontrolya kachestva okazaniya meditsinskoi pomoshchi detyam s tyazheloi travmoi na territorii Rostovskoi oblasti. Prakticheskaya meditsina. 2009;(8):94–95. (In Russ).]

14. Шаршов Ф.Г., Спиридонова Е.А., Румянцев С.А. и др. Протокол работы реанимационно-консультативного центра службы медицины катастроф Ростовской области при оказании экстренной медицинской помощи детям с тяжелыми травматическими повреждениями // Медицина катастроф. — 2010. — Т. 71. — №3. — С. 19–23. [Sharshov FG, Spiridonova EA, Rumyantsev SA, et al. Work Protocol for delivery of emergency medical care to children with severe traumatic injuries of Resuscitation and Consultation Center of Rostov Oblast Service for Disaster Medicine. Meditsina katastrof. 2010;71(3):19–23. (In Russ).]

15. Choi PM, Hong C, Woods S, et al. Early impact of American College of Surgeons- verification at a level-1 pediatric trauma center. J Pediatr Surg. 2016;51(6):1026–1029. doi: 10.1016/j.jpedsurg.2016.02.081.

16. Стажадзе Л.Л., Спиридонова Е.А. Клиническая картина травматического шока // Медицина критических состояний. — 2004. — №5. — С. 29–32. [Stazhadze LL, Spiridonova EA. Klinicheskaya kartina travmaticheskogo shoka. Meditsina kriticheskikh sostoyanii. 2004;(5):29–32. (In Russ).]

17. Кешишян Р.А. Дорожно-транспортный травматизм у детей: медико- организационные аспекты проблемы: автореф. дис. … докт. мед. наук. — М.; 2010. 43 с. [Keshishyan RA. Dorozhnotransportnyi travmatizm u detei: mediko-organizatsionnye aspekty problemy. [dissertation abstract] Moscow; 2010. 43 p. (In Russ).]

18. Костомарова Л.Г., Стажадзе Л.Л., Спиридонова Е.А., Круговых Е.А. Особенности экстренной помощи пострадавшим в чрезвычайных ситуациях мирного времени на догоспитальном этапе // Анестезиология и реаниматология. — 2007. — № 4. — С. 12– 14. [Kostomarova LG, Stazhadze LL, Spiridonova EA, Krugovykh EA. Osobennosti ekstrennoi pomoshchi postradavshim v chrezvychainykh situatsiyakh mirnogo vremeni na dogospital’nom etape. Anesteziol Reanimatol. 2007;(4):12–14. (In Russ).]

19. Tarima S, Ertl A, Groner JI, Cassidy LD. Factors associated with patients transferred from undesignated trauma centers to trauma centers. J Trauma Acute Care Surg. 2015;79(3):378–385. doi: 10.1097/TA.0000000000000763.

20. Baudin F, Floccard B, Desgranges FP, et al. Effectiveness of management of children with severe trauma in a pediatric trauma center and in an adult trauma center: A before after study. Arch Pediatr. 2016;23(4):367-372. doi: 10.1016/j.arcped.2015.12.023.

21. Muhm M, Danko T, Henzler T, et al. Pediatric trauma care with computed tomography criteria for CT scanning. Emerg Radiol. 2015;22(6):613-621. doi: 10.1007/s10140-015-1332- 7.

22. Pandit V, Michailidou M, Rhee P, et al. The use of whole body computed tomography scans in pediatric trauma patients: Are there differences among adults and pediatric centers? J Pediatr Surg. 2016;51(4):649–653. doi: 10.1016/j.jpedsurg.2015.12.002.

23. Kernic MA, Rivara FP, Zatzick DF, et al. Triage of children with moderate and severe traumatic brain injury to trauma centers. J Neurotrauma. 2013;30(13):1129-1136. doi: 10.1089/ neu.2012.2716.

24. Тулупов А.Н., Бесаев Г.М., Синенченко Г.И. Особенности оказания медицинской помощи пострадавшим с сочетанной травмой, полученной при дорожно- транспортных происшествиях в Санкт-Петербурге // Экология человека. — 2015. — № 6. — С. 3–8. [Tulupov AN, Besaev GM, Sinenchenko GI. Features of medical assistance to victims with combined traumas caused by road accidents in Saint-Petersburg. Ekologiya cheloveka. 2015;(6):3–8. (In Russ).]

25. Струк Ю.В., Банин И.Н., Воробьев И.И. и др. Оказание экстренной нейрохирургической помощи на территории Воронежской области // Неотложная медицинская помощь. — 2015. — № 3. — С. 36–39. [Struk YuV, Banin IN, Vorobyev II, et al. Emergency neurosurgical care management in Voronezh Region. Neotlozhnaya meditsinskaya pomoshch’. 2015;(3):36–39. (In Russ).]


Review

For citations:


Chernozubenko A.V., Prometnoy D.V., Sharshov F.G., Prometnaya G.A. Quality of Emergency Hospital Care for Children with Severe Mechanical Traumas in Pediatric and Non-Pediatric In-Patient Hospitals: Results of the Retrospective Cohort Study. Current Pediatrics. 2016;15(4):379-384. (In Russ.) https://doi.org/10.15690/vsp.v15i4.1589

Views: 956


ISSN 1682-5527 (Print)
ISSN 1682-5535 (Online)