Variation in patterns of hospitalization and associated resource use among children with spinal cord injury in the U.S.

Introduction: Trauma is a leading cause of mortality and morbidity among children in the U.S. There is paucity of data on the triage of children with spinal cord injury (SCI) to definitive trauma care, and it is unknown if clinical outcomes and resource utilization for children hospitalized with SCI vary according to the settings where trauma care is provided. The study was conducted to describe recent patterns of emergency department (ED) evaluation for paediatric SCI in the U.S., and to characterize outcomes and resource use for children hospitalized at non-trauma centres versus trauma centres.

Materials And Methods: Secondary analysis of a national database on injured children 0-20 years evaluated at U.S. EDs and either hospitalized or released, in 2009-2012. In-hospital mortality, duration of stay, and overall charges, were compared according to trauma centre status of the treating hospital.

Results: Of an estimated 67 million annual paediatric visits to the ED for trauma evaluation nationally in 2009-2012, 2317 had SCI. Majority (87%) of children evaluated for SCI were under 6 years of age, and boys comprised 73% of the visits. Injuries were caused mainly by motor vehicle accidents, falls, non-transport-related accidents, and firearms. The South census region had the most ED visits and hospitalizations. Majority (92%) of the most severely injured was evaluated at trauma centres, and more visits to trauma centres (81% vs. 18%, p=0.022) resulted in hospitalization. Among an estimated 1570 hospitalizations of children with SCI from the ED nationally, children at trauma centres were more likely to have major injuries (67% vs. 44%, p=0.001), similar mortality, longer average hospital stay, and higher charges, compared with children hospitalized at non-trauma centres.

Conclusion: Significant demographic and geographical variation exists in national patterns of hospital care for paediatric SCI. Higher severity of patient injury was associated with concomitantly higher hospital resource use at trauma centres.