@article{ref1,
title="The effects of regionalization of pediatric trauma care in the Netherlands: A surveillance-based before-after study",
journal="Journal of trauma and acute care surgery",
year="2012",
author="Janssens, Loes and Holtslag, Herman R. and van Beeck, Eduard F. and Leenen, Luke P. H.",
volume="73",
number="5",
pages="1284-1287",
abstract="BACKGROUND: System changes in pediatric trauma care may reduce childhood injury mortality. The Dutch system of trauma care has been regionalized in 1999/2000. We evaluated changes in referral behavior and in-hospital mortality before and after regionalization of trauma care in the Netherlands. METHODS: A surveillance-based before-after study was performed on all children aged up to 18 years that were discharged from one of the hospitals of the trauma care region &quot;Central Netherlands&quot; between 1996 and 1998 and between 2001 and 2006. The in-hospital mortality rate and referral behavior was compared before (1996-1998) and after (2001-2006) regionalization of trauma care in the Netherlands. RESULTS: A total of 21,585 children were included, with a mean (SD) age of 9.6 (5.5) years and a mean (SD) Injury Severity Score (ISS) of 4.3 (4.4). After regionalization, the mean ISS was lower (p = 0.000), and the mean length of stay was lower (p = 0.000). The in-hospital mortality rate was significantly lower for the adolescent group (age, 13-18 years; n = 7,846; standardized mortality ratio, 0.64; 95% confidence interval, 0.34-0.93) after correction for the ISS. No changes were found for the younger children (age, 0-12 years; n = 13,739). No significant differences were found in referral behavior for both age categories. CONCLUSION: Regionalization of trauma care in the Netherlands reduced the in-hospital mortality rates for adolescents in the last decade. However, this reduction was not caused by a change in referral behavior. LEVEL OF EVIDENCE: Therapeutic study, level IV; prognostic/epidemiologic study, level III.<p /> <p>Language: en</p>",
language="en",
issn="2163-0755",
doi="10.1097/TA.0b013e318265d0ac",
url="http://dx.doi.org/10.1097/TA.0b013e318265d0ac"
}