Association for Academic SurgeryA Mathematical Model to Predict Length of Stay in Pediatric ATV Accident Victims
Introduction
All-terrain vehicles (ATVs) are three- or four-wheeled vehicles with gasoline powered engines driven primarily on venues other than paved roads. They are known to have a high center of gravity and narrow wheelbase, which makes them particularly dangerous in the context of a high speed accident. Current estimates of ATVs in use in the United States are in excess of 7 million, and newer models can attain weights over 600 pounds and reach speeds of greater than 75 miles per hour [1].
The US Consumer Product Safety Commission (CPSC) collects data related to ATV injuries and deaths in the United States and helps in making recommendations to manufacturers and distributors as well as the public on safe ATV practices. They found that from January 1, 1982 to December 31, 2008 there were a total of 9633 ATV-related fatalities and 2588 of these were found to be in people younger than age 16 y [2]. Additionally, the CPSC looked at emergency department (ED) admissions for ATV-related accidents in 2008 for this age group and found that 37,700 injuries occurred in patients under the age of 16 y. This accounted for approximately 30% of all ATV-related injuries in the United States during the year of 2008 [2].
We also know from prior works that almost 80% of the deaths that occur from ATV-related accidents in the pediatric population occur in patients under the age of 16 y [3]. According to the CPSC’s National Electronic Injury Surveillance System (NEISS) data highlights from 2009 ATVs accidents resulted in 28,383 hospitalizations or deaths on arrival to the ED [4]. For hospitalized pediatric ATV accident victims, this translates into an average annual cost of $5.2 million and then $1.4 billion in ED visit costs for these patients [5].
Works looking at ATV use in the pediatric population found that of all hospitalizations during an 11-y period at a pediatric trauma center, 34% of the patients were admitted to the intensive care unit (ICU) secondary to severity of injuries [6]. They also reported that in the more recent years of their study, there were a higher proportions of patients going to the ICU than in earlier years, presumably for worse injuries. This increase in ICU admissions can be said to put a greater strain on healthcare resources.
With cost of care increasing, availability of healthcare workers decreasing, and increase in the number of ATV-related accidents in children, we felt it would be beneficial to attempt to find a way to predict total hospital length of stay in these patients. Herein, we propose a novel mathematical model to help predict hospital length of stay in the pediatric ATV accident victim.
Section snippets
Methods
After obtaining institutional review board (IRB) approval, we performed a retrospective review of the trauma registry for all pediatric patients who were involved in ATV accidents from January 1, 2000 to December 31, 2009. Pediatric patients were defined as those under the age of 18 y old. This resulted in a population of 420 subjects. We analyzed parameters of age, Glasgow Coma Score (GCS), presence of helmet, presence of closed head injury (CHI), injury severity score (ISS), systolic blood
Results
Collinearity diagnostics found acceptable tolerance levels at or above 0.8 for ISS (0.80), GCS (0.81), and CHI (0.85). The Durbin-Watson statistic yielded was 0.65, which is expected due to the use of a higher-order logarithmic transformation and thus does not warrant a possible violation [7]. The standardized residuals were normally distributed, the P-P plot of standardized residuals was acceptable, and there was no violation of the assumption of homoscedasticity.
Before the hierarchical
Discussion
According to the Health Resources and Services Administration report to Congress, there will be a 35% shortage of intensivists by the year 2020 [8]. As stated earlier, there is an overall decline in the number of primary care physicians and healthcare workers in recent years and, thus, less available resources to help in patient care. Between 1993 and 2001, ATV-related injuries in children in the U.S. increased by 94%. Children younger than 16 y of age account for 14% of ATV riders nationally,
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