부산대학교 도서관

Byline: Samir M. Fakhry, Center for Trauma and Acute Care Surgery Research, HCA Healthcare, Clinical Services Group, Nashville, Tennessee (Drs Fakhry, Shen, Garland, and Watts, Mss Wilson and Morse, and Mr Wyse); Trauma Services, Wesley Medical Center, Wichita, Kansas (Dr Berg); Trauma Services, Mission Hospital, Asheville, North Carolina (Dr Slivinski and Ms Franklin); Trauma Services, Grand Strand Medical Center, Myrtle Beach, South Carolina (Mr Worthley and Dr Rhodes); Office of Research Oversight, Chippenham Hospital, Richmond, Virginia (Ms Brady); Department of Trauma and Surgical Critical Care (Dr Dunne) and Trauma Services (Ms Palladino), Memorial Health University Medical Center, Savannah, Georgia; and Pediatric Trauma, Medical City Children's Hospital, Dallas, Texas (Ms Turner).; Gina M. Berg; Nina Y. Wilson; Andrea Slivinski; Jennifer L. Morse; Yan Shen; Ransom J. Wyse; Jeneva M. Garland; Aaron Worthley; Jessica L. Brady; Kelli Franklin; James R. Dunne; Jennifer Turner; Heather Rhodes; Kelsey Palladino; Dorraine D. Watts Abstract BACKGROUND: Only a fraction of pediatric trauma patients are treated in pediatric-specific facilities, leaving the remaining to be seen in centers that must decide to admit the patient to a pediatric or adult unit. Thus, there may be inconsistencies in pediatric trauma admission practices among trauma centers. OBJECTIVE: Describe current practices in admission decision making for pediatric patients. METHODS: An email survey was distributed to members of three professional organizations: The American Association for the Surgery of Trauma, Society of Trauma Nurses, and Pediatric Trauma Society. The survey contained questions regarding pediatric age cutoffs, institutional placement decisions, and scenario-based assessments to determine mitigating placement factors. RESULTS: There were 313 survey responses representing freestanding children's hospitals (114, 36.4%); children's hospitals within general hospitals (107, 34.2%), and adult centers (not a children's hospital; 90, 28.8%). The mean age cutoff for pediatric admission was 16.6 years. The most reported cutoff ages were 18 years (77, 25.6%) and 15 years (76, 25.2%). The most common rationales for the age cutoffs were 'institutional experience/tradition' (139, 44.4%) and 'physician preference' (89, 28.4%). CONCLUSION: There was no single widely accepted age cutoff that distinguished pediatric from adult trauma patients for admission placement. There was significant variability between and within the types of facilities, with noted ambiguity in the definition of a 'pediatric' patient. Thresholds appear to be based primarily on subjective criteria such as traditions or preferences rather than scientific data. Institutions should strive for objective, evidence-based policies for determining the appropriate placement of pediatric patients.