Referral pattern for Pediatric Trauma Patients at a Level 1 Trauma Center

Rachel Eisenhauer, BS
Harman Sawhney, MD
Kevin Rix, PhD, MPH
Michelle Ruda, MD
Irma Ugalde, MD
Bibek Bista, MBBS, MPH

Level 1 Pediatric trauma requires multidisciplinary care including our community partners. However, there is a paucity of literature regarding categorizing incidence of multidisciplinary care during the hospitalization and follow up of patients with serious pediatric trauma. This is valuable information for communication between health care organizations and community partners. Our study aims to categorize these referral patterns for serious pediatric trauma at a Level 1 Trauma Center with comparison of unintentional and intentional trauma with mortality and survival.

The subjects were identified from a Level 1 Trauma center’s trauma registry between January 2019 to December 2020 among patients aged 0-18 years with serious pediatric trauma. Serious pediatric trauma was defined as trauma that either led to death or admission to the Intensive Care Unit (ICU). A retrospective chart review was performed from hospital Electronic Medical Record, and pertinent data was obtained from the Medical Examiner’s office and Texas Department of Family Protective Services (DFPS)/Child Protective Services (CPS). Statistical analysis was done using t-tests and Chi-square tests.

There were 263 subjects identified as having serious pediatric trauma during the study period. Among them, 224/263 (85%) experienced non-intentional trauma and 39/263 (15%) experienced intentional trauma. Most frequent mechanism of injury among non-intentional trauma subjects was Motor Vehicle Collision (MVC) (92/224, 41%) and among non-intentional trauma was Gun Shot Wound (GSW) (23/39, 59%). Intentional trauma patients were more likely to have mortality compared to non-intentional trauma (13% vs 41%, 28/224 vs 16/39, p =< 0.001). The Child Abuse Pediatric (CAP) team was statistically more likely to see intentional trauma compared to non-intentional trauma (26% vs.12%, p = 0.01). In GSW non-intentional trauma, social work was consulted in 79% and CAP team in 3% of cases. In subjects where CAP was consulted, social work was consulted in 100% of those cases. For the intentional trauma subjects admitted to the PICU, social work was consulted 100% of the time, while the CAP team was only consulted for 43%. Of the 44/263 mortality cases, social work was consulted in 71%, CAP team in 11%, and DFPS/ CPS reporting was done in 30% of cases.

Findings from this study help to evaluate the pattern of referral and reporting in Level 1 pediatric trauma. There were missed opportunities for involving social work, CAP team, and reporting to DFPS for specific types of serious pediatric trauma and potential suboptimal care. Findings from this study help to implement processes to have timely consults and reporting to our in-hospital services and community partners.

1. Describe the nature, mechanism of injury and associated mortality among serious Pediatric Trauma in a Level 1 Trauma Center.
2. Describe the types of trauma and patterns of referrals made at a Level 1 Trauma center.
3. Discuss the missed opportunities for involvement of social work, the CAP team, and CPS.