Abstract
Purpose
There is a lack of data-driven, risk-adjusted mortality estimates for injured children outside of high-income countries (HIC). To inform injury prevention and quality improvement efforts, an upper middle-income country (UMIC) pediatric trauma registry was compared to that of a HIC.
Methods
Clinical data, injury details, and mortality of injured children (< 18 years) hospitalized in two centers (USA and South African (SA)) from 2013 to 2017 were abstracted. Univariate and multivariable analyses evaluated risk of mortality and were expressed as odds ratios (OR) with 95% confidence intervals (CI).
Results
Of 2089 patients, SA patients had prolonged transfer times (21.1 vs 3.4 h) and were more likely referred (78.2% vs 53.9%; both p < 0.001). Penetrating injuries were more frequent in SA (23.2% vs 7.4%, p < 0.001); injury severity (9 vs 4) and shock index (0.90 vs 0.80) were greater (both p < 0.001). SA utilized cross-sectional imaging more frequently (66.4% vs 37.3%, p < 0.001). In-hospital mortality was similar (1.9% SA, 1.3% USA, p = 0.31). Upon multivariable analysis, ISS > 25 [210.50 (66.0-671.0)] and penetrating injury [5.5 (1.3–23.3)] were associated with mortality, while institution [1.7 (0.7–4.2)] was not.
Conclusions
Despite transfer time, the centers demonstrated comparable survival rates. Comparison of registry data can alert clinicians to problematic practice patterns, assisting initiatives to improve trauma systems.
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Appendix 1
Appendix 1
The definitions of low-, middle-, lower middle-, upper middle-, and high-income countries are included below. These definitions are based upon Gross National Income (GNI) per capita using the World Bank Atlas method for the 2019 fiscal year. They can be found at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519.
Classification | World Bank definition |
|---|---|
Low income | Low-income economies are those with GNI per capita of $995 or less in 2017 |
Lower middle income | Lower middle-income economies are those with a GNI per capita of more than $995 but less than $3896 |
Middle income | Middle-income economies are those with a GNI per capita between $996 and $12,055 |
Upper middle income | Upper middle-income economies those with a GNI per capita of more than $3895 but less than $12,056 |
High income | High-income economies are those with a GNI per capita of $12,056 or more |
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Traynor, M.D., Hernandez, M.C., Shariq, O. et al. Trauma registry data as a tool for comparison of practice patterns and outcomes between low- and middle-income and high-income healthcare settings. Pediatr Surg Int 35, 699–708 (2019). https://doi.org/10.1007/s00383-019-04453-w
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DOI: https://doi.org/10.1007/s00383-019-04453-w