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Objective: To assess the variation in hospital and intensive care unit (ICU) length of stay (LOS) for injury admissions across Canadian provinces and to evaluate the relative contribution of patient case mix and treatment-related factors (intensity of care, complications, and discharge delays) to explaining observed variations. Background: Identifying unjustified interprovider variations in resource use and the determinants of such variations is an important step towards optimizing health care. Methods: We conducted a multicenter, retrospective cohort study on admissions for major trauma (injury severity score >12) to level I and II trauma centers across Canada (2006-2012). We used data from the Canadian National Trauma Registry linked to hospital discharge data to compare risk-adjusted hospital and ICU LOS across provinces. Results: Risk-adjusted hospital LOS was shortest in Ontario (10.0 days) and longest in Newfoundland and Labrador (16.1 days; P < 0.001). Risk-adjusted ICU LOS was shortest in Québec (4.4 days) and longest in Alberta (6.1 days; P < 0.001). Patient case-mix explained 32% and 8% of interhospital variations in hospital and ICU LOS, respectively, whereas treatment-related factors explained 63% and 22%. Conclusions: We observed significant variation in risk-adjusted hospital and ICU LOS across trauma systems in Canada. Provider ranks on hospital LOS were not related to those observed for ICU LOS. Treatment-related factors explained more interhospital variation in LOS than patient case-mix. Results suggest that interventions targeting reductions in low-value procedures, prevention of adverse events, and better discharge planning may be most effective for optimizing LOS for injury admissions. [ABSTRACT FROM AUTHOR]

Objective: To measure the variation in trauma center mortality across Canadian trauma systems, assess the contribution of traumatic brain injury and thoracoabdominal injury to observed variations, and evaluate whether the presence of recommended trauma system components is associated with mortality. Summary Background Data: Injuries represent one of the leading causes of mortality, disability, and health care costs worldwide. Trauma systems have improved injury outcomes, but the impact of trauma system configuration on mortality is unknown. Methods: We conducted a retrospective cohort study of adults admitted for major injury to trauma centers across Canada (2006–2012). Multilevel logistic regression was used to estimate risk-adjusted hospital mortality and assess the impact of 13 recommended trauma system components. Results: Of 78,807 patients, 8382 (10.6%) died in hospital including 6516 (78%) after severe traumatic brain injury and 749 (9%) after severe thoracoabdominal injury. Risk-adjusted mortality varied from 7.0% to 14.2% across provinces (P < 0.0001); 11.1% to 26.0% for severe traumatic brain injury (P < 0.0001), and 4.7% to 5.9% for thoracoabdominal injury (P = 0.2). Mortality decreased with increasing number of recommended trauma system elements; adjusted odds ratio = 0.93 (0.87–0.99). Conclusions: We observed significant variation in trauma center mortality across Canadian provinces, specifically for severe traumatic brain injury. Provinces with more recommended trauma system components had better patient survival. Results suggest that trauma system configuration may be an important determinant of injury mortality. A better understanding of which system processes drive optimal outcomes is required to reduce the burden of injury worldwide. [ABSTRACT FROM AUTHOR]

Wilms tumor weight was used to recruit patients in a recent National Wilms Tumor Study (NWTS) group trial. The authors hypothesized that a simple calculation of tumor volume based on a preoperative CT scan could predict tumor weight. The authors reviewed charts and CT images of patients with Wilms tumors who were treated at their institution between 1985 and 2002. Tumor volume was calculated as: V = 1/6pi x d (long axis) x d (short axis) x d (craniocaudal). Weight and calculated tumor volume were correlated using linear regression. Complete data of tumor weight and volume could be determined in 25 of the 49 patients. These were highly correlated (Spearman R = 0.97). Wilms tumor weight can be predicted based on a simple estimate of tumor volume on a preoperative CT scan. CT-estimated volume may replace weight as a prognostic factor and in guiding management.

Background: Use of all-terrain vehicles (ATVs) has become a popular recreational activity for all ages, yet children suffer a markedly higher proportion of ATV-related injuries and deaths compared with the adult population. Evidence needs to be developed to direct policy to eliminate unnecessary injuries in this population., Methods: A review of children younger than 16 years old admitted to a tertiary pediatric trauma center with ATV-related injuries over 12.5 years was conducted. Data included demographics, mechanisms of injury, use of helmets, and outcomes., Results: Of 92 patients, 79% were male, the mean age was 12.1 years, 16% were under 10 years old, and 10% had attention deficit hyperactivity disorder (general population prevalence, 1-4%). Flipping/rolling was the most common mechanism of injury (32%) and was associated with sustaining chest and abdominal injuries (odds ratio, 3.7; 95% confidence interval, 1.1-12.9) and an increased Injury Severity Score (ISS). Only 4 of 20 patients with head/facial injuries were using helmets compared with 37 of 40 (odds ratio of head injury with helmet use, 0.02; 95% confidence interval, 0.004-0.101). Forty-five patients had more than one body system injured. The mean ISS was 7.0 (range, 1-35), and high scores were associated with sustaining head and/or truncal injuries. Fourteen percent of cases had an ISS greater than or equal to 12 and two patients died. The median length of stay was 3 days; 12% were admitted over 2 weeks., Conclusion: Children continue to sustain a large proportion of preventable and unnecessary injuries caused by ATVs. Although use of protective devices (i.e., helmets) diminishes the extent of injuries, children's smaller size relative to these large machines may contribute to flipping, rolling, and loss of control. Increased risk-taking by those with attention deficit hyperactivity disorder may also play a role. Efforts are needed to lobby for policies to limit the promotion and restrict the use of ATVs by children.