Details

Autor(en) / Beteiligte

• Fortin, Mélyssa
• Atsaidis, Zoe
• Hopkins, Brent
• St-Louis, Etienne
• Guadagno, Elena
• Friedman, Debbie
• Poenaru, Dan

Titel

Definitive Care for Severely Injured Children in Quebec

Ist Teil von

• Injury, 2023-01, Vol.54 (1), p.173-182

Ort / Verlag

Netherlands: Elsevier Ltd

Erscheinungsjahr

2023

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• •Injury remains the leading and most common cause of death in children above the age of one in Quebec.•In Northern Quebec, injury is the leading cause of death in children, occurring at a rate that is 3 to 4 times higher than the national average.•Patients from Northern Quebec were significantly more likely to experience a longer length of hospitalization than their counterparts.•A more sophisticated pre-hospital trauma system allowing for better and culturally sensitive treatment of patients from all of Quebec is needed. Injury is the leading cause of death in children over the age of one in Canada, and remains the most common cause of death in Quebec pediatric patients. Indigenous communities are 3–4 times more likely to be affected by injuries than the national average. In Quebec, health centres can range from 30 to 1000 km away from the closest level I trauma center. Descriptive analysis and multiple logistic regression were performed for severely injured pediatric trauma patients received at the Montreal Children's Hospital (MCH) over a ten-year period. Outcomes were compared between regional groups in Quebec using forward sortation areas. Two hundred and forty four pediatric patients presented to the MCH with major trauma between 2006 and 2016. Of those, 42% of patients resided in Montreal, 42% off-island, and 16% in Northern Quebec. Admission to the Intensive Care Unit (ICU) was required for 60% of off-island patients and 58% of Northern residents. The median length of hospital stay (LOS) was 5 days for off-island and 15 days for Northern patients. Most patients (78% off-island vs. 76% Northern Quebec) were discharged home. The overall mortality was 5%. In multiple regression analysis, residence in Northern Quebec was associated with increased incidence of longer than median length of stay compared to off-island patients (OR 2.78, 95%CI (1.12–7.29)) after adjusting for injury severity, operative intervention, age, and sex. ICU admission rate was similar among Northern and off-island populations. Patients from Northern Quebec appeared to have longer-than-median hospital length of stay. In-hospital mortality was infrequent and limited to on-island and off-island populations. A further exploration of this data is required to identify the “trauma deserts” and advocate for children involved in trauma in all areas of Quebec.