Comparing complications in pediatric trauma patients transported before and after 30 minutes

Abstract

Introduction: The "golden hour" principle emphasizes rapid patient transport and intervention to improve adult trauma outcomes, but its relevance to pediatric patients is uncertain. This study examined whether a <30 min prehospital transport time was associated with improved outcomes compared to the previous 60 min threshold for mortality and morbidity.

Method: The National Trauma Data Bank (NTDB) was queried for pediatric patients (ages 4-16) transported under 1 h and dichotomized by EMS transport time (<30 or ≥30 min). Exclusions included non-severe injury severity score (ISS ≤15), fatal injuries, deaths on arrival, and non-blunt mechanisms of injury. Baseline characteristics, including age, sex, ISS, Glasgow coma score (GCS), shock index (SI), and pediatric-adjusted shock index (SIPA), were compared between groups. Multivariable regression determined the likelihood of the primary outcome, mortality, with secondary outcomes including hospital complications.

Results: Of 3325 pediatric patients, 920 (27.7 %) were transported <30 min and 2405 (72.3 %) ≥30 min. In the ≥30 min' group, 64.3 % (p = 0.27) were male, 62.8 % (p = 0.24) adolescents (age 12-16), 7.4 % (p = 0.01) severe SI (>1.4), 30.0 % (p = 0.14) elevated SIPA, and 19.1 % (p < 0.001) severe GCS (3-8). Mortality was 8.8 % for <30 and 4.7 % for ≥30 min (p < 0.001). A transport ≥30 min was strongly associated with increased likelihood of renal complications (OR 4.0, CI 1.1-19.6). Further, changing transport time by 5 min intervals revealed the thresholds at which mortality and complications, both aggregated and disaggregated increase drastically: aggregated hospital complications (OR 1.7, CI 1.0-3.0), operating room procedures (OR 2.7, CI 1.1-6.8), unplanned ICU admissions (OR 2.9, CI 1.1-8.8), intubation (OR 4.0, CI 1.5-12.5), and pressure ulcer (OR 3.0, CI 1.2-8.5) at the ≥25 min threshold; clots (OR 8.9, CI 2.4-58.0), respiratory (OR 10.3, CI 1.9-191.5), cardiac arrest (OR 3.0, CI 1.2-8.1), pneumonia (OR 7.0, CI 1.7-47.9), and DVT (OR 10.6, CI 1.9-199.5) at the ≥20 min threshold; and mortality (OR 2.7, CI 1.1-7.7) and infection (OR 5.4, CI 1.7-24.3) at the ≥15 min threshold.

Conclusion: Pediatric trauma patients with ≥30 min prehospital transport time have an increased likelihood of subsequent hospital mortality and morbidity, highlighting the need for early outcome prediction to guide timely interventions and reduce preventable mortality and morbidity.

Study type: Retrospective large database cohort analysis.

Level of evidence: III.

Keywords: 30 min; Complications; Golden hour; Mortality; National trauma data bank; Pediatric.