Introduction: Trauma is a leading cause of U.S. child mortality and morbidity. Given a paucity of data on triage of children with spinal cord injury (SCI) to definitive trauma care, the study assessed recent patterns of emergency department (ED) evaluation and hospitalization for pediatric SCI and tested the hypothesis that outcomes will be worse at non-trauma centers (NTC) than trauma centers (TC).
Methods: Retrospective study of children 0-20 years evaluated for injuries at U.S. EDs and either hospitalized or released, in 2016 – 2022, using the Nationwide Emergency Department Sample. Multivariable regression models assessed the relationship between hospital TC status and in-hospital outcomes of mortality, length of stay (LOS), and overall charges, controlling for potential confounders.
Results: Of estimated 20,936 pediatric ED visits nationally for SCI, 77% were to TCs. Boys comprised 60% of the visits and most (89%) visits involved patients >10 years. SCI was most often caused by motor vehicle accidents and falls. The South census region had the most ED visits and subsequent hospitalizations. Most (89%) major injuries (injury severity score >15) were evaluated at TC EDs, and more visits to TCs versus NTCs (58% vs 5%, p < 0.01) led to subsequent hospitalization. Among estimated 9,617 SCI hospitalizations from the ED, 97% were to TCs, with associated higher use of invasive medical devices, higher unadjusted mortality (3.9 vs 2.3%, p< 0.01), longer unadjusted mean LOS (9.4 vs 4.6 days, p< 0.01) and higher hospital charges than NTCs. Multivariable regression revealed statistically similar adjusted mortality (Odds Ratio: 0.59; 95% Confidence Interval [CI] 0.27,1.33; p = 0.20) and incremental hospital charges (-$10,690; 95% CI: -$38,854, 17,474; p = 0.46) at TCs and NTCs, while LOS (Incidence Rate Ratio:1.39; 95%CI: 1.15,1.69; p < 0.01) was higher at TCs.
Conclusions: Significant demographic and geographical variation exists in national patterns of hospital care for pediatric SCI. Despite disproportionately higher burden of severely injured patients, TCs had similar adjusted mortality and overall hospital charges to NTCs. The study findings highlight important opportunities for further research into approaches to mitigate pediatric SCI and enhance quality of care factors that might influence clinical outcomes.
