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Seasonal, Weather, and Temporal Factors in the Prediction of Admission to a Pediatric Trauma Center.

ABSTRACT: BACKGROUND:Our objective is to identify seasonal and weather trends associated with pediatric trauma admissions. METHODS:We reviewed all trauma activations leading to admission in patients ?18 years admitted to a regional pediatric trauma center from January 1, 2000, to December 31, 2015. We reviewed climatologic measures of the mean temperature, mean visibility, and precipitation for each admission in the 6 h prior to each presentation in addition to time of arrival, weekday/weekend presentation, and season. We used a negative binomial regression model with multivariable analysis to estimate associations between weather and rate of trauma admissions. Results were presented as incidence rate ratios (IRR) with 95% confidence intervals (CI). RESULTS:In total, 3856 encounters [2539 males (65.8%), mean age 10.2 years?±?SD 5.1 years] were included. Results from multivariable analysis (IRR, 95% CI) suggested an association of admissions with rain (0.82, 0.75-0.90) and overnight hours (23:51-05:50; 0.69, 0.58-0.82) as compared to morning (05:51-11:50). The IRR of trauma increased during the afternoon (11:51-17:50; 4.05, 3.57-4.61), night periods (17:51-23:50; 5.59, 4.94-6.33), and weekends (1.24, 1.15-1.32), and with every 1 °C increase in temperature (1.04, 1.03-1.04). After accounting for other variables, season was not found to be independently predictive of trauma admission. CONCLUSION:Trauma admissions had a higher rate during afternoon, evening hours, and weekends. The presence of rain lowered the rate of pediatric trauma admission. Each degree increase in temperature increased the rate of trauma admissions by 4%. The findings provide information from the perspective of emergency preparedness, resource utilization, and staffing to pediatric trauma centers.

SUBMITTER: Ramgopal S

PROVIDER: S-EPMC7237022 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Seasonal, Weather, and Temporal Factors in the Prediction of Admission to a Pediatric Trauma Center.

Ramgopal Sriram S Dunnick Jennifer J Siripong Nalyn N Conti Kavitha A KA Gaines Barbara A BA Zuckerbraun Noel S NS

World journal of surgery 20190901 9

<h4>Background</h4>Our objective is to identify seasonal and weather trends associated with pediatric trauma admissions.<h4>Methods</h4>We reviewed all trauma activations leading to admission in patients ≤18 years admitted to a regional pediatric trauma center from January 1, 2000, to December 31, 2015. We reviewed climatologic measures of the mean temperature, mean visibility, and precipitation for each admission in the 6 h prior to each presentation in addition to time of arrival, weekday/week ...[more]

PMID: 31098667

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Project description:BackgroundPediatric trauma, particularly major trauma cases, are often treated in less than optimal facilities by providers who lack training and experience in treating severely injured children. We aimed to develop a management model for admission and treatment of pediatric trauma using the Theory of Constraints (TOC).MethodsWe conducted interviews with 17 highly experienced policy makers, senior nursing managers and medical managers in pediatrics and trauma. The interviews were analyzed by qualitative methods. The TOC was utilized to identify undesirable effects (UDEs) and core challenges, and to design a focused current reality tree (CRT). Subsequently, a management model for optimal admission and treatment of pediatric trauma was constructed.ResultsThe CRT was illustrated according to 4 identified UDEs focusing on lack of: (1) clear definitions of case manager in pediatric trauma; (2) uniform criteria regarding the appropriate site for admitting pediatric trauma, (3) standard guidelines and protocols for treatment of trauma cases and for training of trauma medical teams; and (4) standard guidelines for evacuating pediatric trauma patients. The management model for treatment and admission of pediatric trauma is based on 3 major elements: human resources, hospital policy concerning the appropriate emergency department (ED) for pediatric trauma patients and clear definitions regarding children and trauma levels. Each of the elements contains components that should be clearly defined in order for a medical center to be designated for admitting and treating pediatric trauma patients.ConclusionsOur analysis suggests that the optimal ED for pediatric trauma cases is one with available operating rooms, intensive care beds, an imaging unit, laboratories and equipment suitable for treating children as well as with staff trained to treat children with trauma. To achieve optimal outcomes, medical centers in Israel should be classified according to their trauma treatment capabilities and their ability to treat varied severities of pediatric trauma cases.

Project description:IntroductionThe influence of reduced functional status has become increasingly relevant because of the gradual decline in mortality rate over the recent years. Nonetheless, only a few studies investigating the functional status of patients with trauma at hospital discharge have been conducted. This study aimed to identify the risk factors influencing the mortality rate in pediatric trauma survivors at a pediatric intensive care unit and analyze their functional status using the Functional Status Scale (FSS).MethodsA retrospective analysis was conducted at Shengjing Hospital of China Medical University. Children admitted to the pediatric intensive care unit between January 2015 and January 2020 who met the trauma diagnostic criteria were included. The FSS score and the Injury Severity Score (ISS) were recorded upon admission and discharge, respectively. Clinical data were compared between the survival and non-survival groups to identify the risk factors for poor prognosis. The risk factors for mortality were identified using multivariate and univariate analyses.ResultsA total of 246 children {59.8%, male; median [interquartile range (IQR)] age: 3 [1-7] years} were diagnosed with trauma (including head trauma, chest trauma, abdominal trauma, and extremity trauma). Of these patients, 207 were discharged, 11 dropped out mid-treatment, and 39 died (hospital mortality rate, 15.9%). Upon admission, the median FSS and trauma scores were 14 (IQR, 11-18) and 22 (IQR, 14-33) points, respectively. At discharge, the FSS score was 8 (IQR, 6-10) points. The patient clinical status improved with a ΔFSS score of -4 (IQR, -7, 0) points. At hospital discharge, 119 (48.3%), 47 (19.1%), 27 (11.0%), 12 (4.8%), and 2 (0.9%) survivors had good, mildly abnormal, moderately abnormal, severely abnormal, and very severely abnormal function, respectively. Reduced functional status in patients was categorized as follows: motor, 46.4%; feeding, 26.1%; sensory, 23.2%; mental, 18.4%; and communication, 17.9%. In the univariate analysis, ISS >25 points, shock, respiratory failure, and coma were independently associated with the mortality rate. Multivariate analysis revealed that the ISS was an independent risk factor for mortality.ConclusionThe mortality rate of patients with trauma was high. ISS was an independent risk factor for mortality. Mildly reduced functional status remained at discharge and was reported in nearly half of the discharged patients. Motor and feeding functions were the most severely impacted domains.

Project description:Background: Fluctuations in emergency medical services (EMS) responses can have a substantial impact on the ability of agencies to meet resource needs within an EMS system. We aimed to identify weather characteristics as potentially predictable factors associated with EMS responses. Methods: We reviewed hourly counts of scene responses documented by 24 EMS agencies in Western Pennsylvania from January 1, 2014 to December 31, 2017 and compared rates of responses to weather characteristics. Responses to counties nonadjacent to the studied weather reporting station and interfacility/scheduled transports were excluded. We identified the mean temperature, meters visibility, dew point, wind speed, total millimeters of precipitation, and presence of rain or snow in 6-hour windows prior to dispatch, in addition to temporal factors of time of day and weekend vs. weekday. Analysis was performed using multivariable linear regression of a negative binomial distribution, reporting incidence rate ratios (IRR) with 95% confidence intervals (CI). Secondary analyses were performed for transports to the hospital and cases involving transports for traumatic complaints and pediatric patients (age <18?years). Results: We included 529,058 responses (54.8% female, mean age 57.2?±?SD 24.7?years). In our multivariable model, responses were associated with (IRR, 95% CI) rain (1.10, 1.08-1.11) snow (1.07, 1.05-1.09), and both rain and snow (1.15, 1.11-1.19). A lower incidence of responses occurred on weekends (0.84, 0.83-0.85) and at night (0.62, 0.61-0.62). Increasing temperature in 5?°C increments was associated with an increase in responses across seasons with an effect that varied between 1.16 (1.15-1.17) in winter to 1.31 (1.28-1.33) in summer. Windy weather was associated with increased responses from light breeze (1.10, 1.09-1.11) to fresh breeze or greater (1.23, 1.16-1.30). Transports occurred in a similar pattern to responses. Trauma transports (n?=?64,235) occurred more during weekends (1.04, 1.02-1.06). Pediatric transports (n?=?21,880) were not significantly associated with precipitation or season. Conclusion: EMS responses increased with rising temperature and following rain and snow. These findings may assist in planning by EMS agencies and emergency departments to identify periods of greatest resource utilization.

Dataset Information

Seasonal, Weather, and Temporal Factors in the Prediction of Admission to a Pediatric Trauma Center.

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Seasonal, Weather, and Temporal Factors in the Prediction of Admission to a Pediatric Trauma Center.

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