Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-22T21:37:15.940Z Has data issue: false hasContentIssue false

Children and Terror Casualties Receive Preference in ICU Admissions

Published online by Cambridge University Press:  08 April 2013

Abstract

Objective: Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events.

Methods: Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry.

Results: All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU.

Conclusions: Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.

(Disaster Med Public Health Preparedness. 2012;6:14–19)

Type
Original Research
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Chang, DC, Bass, RR, Cornwell, EE, Mackenzie, EJ.Undertriage of elderly trauma patients to state-designated trauma centers. Arch Surg. 2008;143 (8):776781, discussion 782.CrossRefGoogle ScholarPubMed
2.Rose, JH, O’Toole, EE, Dawson, NV, et alAge differences in care practices and outcomes for hospitalized patients with cancer. J Am Geriatr Soc. 2000;48 5(suppl)S25S32.CrossRefGoogle ScholarPubMed
3.Hamel, MB, Lynn, J, Teno, JM, et alAge-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT. J Am Geriatr Soc. 2000;48 5(suppl)S176S182.Google Scholar
4.Persad, G, Wertheimer, A, Emanuel, EJ.Principles for allocation of scarce medical interventions. Lancet. 2009;373 (9661):423431.Google Scholar
5.Truog, RD, Brock, DW, Cook, DJ, et alfor the Task Force on Values, Ethics, and Rationing in Critical Care (VERICC). Rationing in the intensive care unit. Crit Care Med. 2006;34 (4):958963, quiz 971.Google Scholar
6. McKie, J, Richardson, JNeglected equity issues in cost-effectiveness analysis. In: Severity of Pre-treatment Condition, Realization of Potential for Health, Concentration and Dispersion of Health Benefits, and Age-related Social Preferences. Melbourne, Australia: Centre for Health Program Evaluation; 2005:pt 1.Google Scholar
7.Jagsi, R, DeLaney, TF, Donelan, K, Tarbell, NJ.Real-time rationing of scarce resources: the Northeast Proton Therapy Center experience. J Clin Oncol. 2004;22 (11):22462250.CrossRefGoogle ScholarPubMed
8.Swenson, MD.Scarcity in the intensive care unit: principles of justice for rationing ICU beds. Am J Med. 1992;92 (5):551555.Google Scholar
9.Hirshberg, A.Multiple casualty incidents: lessons from the front line. Ann Surg. 2004;239 (3):322324.Google Scholar
10.Wilson, N, Thomson, G.Deaths from international terrorism compared with road crash deaths in OECD countries. Inj Prev. 2005;11 (6):332333.CrossRefGoogle ScholarPubMed
11.Peleg, K, Aharonson-Daniel, L, Stein, M, et alIsraeli Trauma Group (ITG). Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg. 2004;239 (3):311318.Google Scholar
12.Beattie, TF, Currie, CE, Williams, JM, Wright, P.Measures of injury severity in childhood: a critical overview. Inj Prev. 1998;4 (3):228231.Google Scholar
13.Klein, Y, Klein, M, Peleg, K.ICU triage in terror-related mass casualty events. Crit Care. 2009;13(suppl 1)464 doi: 10.1186/cc7628.Google Scholar
14.Champion, HR, Sacco, WJ, Carnazzo, AJ, Copes, W, Fouty, WJ.Trauma score. Crit Care Med. 1981;9 (9):672676.Google Scholar
15.Knaus, WA, Zimmerman, JE, Wagner, DP, Draper, EA, Lawrence, DE.APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981;9 (8):591597.Google Scholar
16.Eastridge, BJ, Owsley, J, Sebesta, J, et alAdmission physiology criteria after injury on the battlefield predict medical resource utilization and patient mortality. J Trauma. 2006;61 (4):820823.Google Scholar
17.Beauchamp, TL, Childress, JFPrinciples of Biomedical Ethics. 4th ed. New York, NY: Oxford University Press; 1994:327-370.Google Scholar
18.Aharonson-Daniel, L, Waisman, Y, Dannon, YL, Peleg, KMembers of the Israel Trauma Group. Epidemiology of terror-related versus non-terror-related traumatic injury in children. Pediatrics. 2003;112 (4):e280.Google Scholar
19.Sprung, CL, Geber, D, Eidelman, LA, et alEvaluation of triage decisions for intensive care admission. Crit Care Med. 1999;27 (6):10731079.Google Scholar
20.Cookson, R, Dolan, P.Principles of justice in health care rationing. J Med Ethics. 2000;26 (5):323329.Google Scholar
21.Kluge, EH.Social values, socioeconomic resources, and effectiveness coefficients: an ethical model for statistically based resource allocation. Ann N Y Acad Sci. 2000;913:2331.Google Scholar
22.Society of Critical Care Medicine Ethics Committee. Consensus statement on the triage of critically ill patients. JAMA. 1994;271 (15):12001203.Google Scholar
23.Kimery, AL.Children must be priority during disaster, survey found. HSToday.us. October 26, 2010. http://www.hstoday.us/index.php?id=483&cHash=081010&tx_ttnews[tt_news]=15458. Accessed February 7, 2012.Google Scholar
24.Zhou, Y, Baker, TD, Rao, K, Li, G.Productivity losses from injury in China. Inj Prev. 2003;9 (2):124127.Google Scholar
25.Burrows, C, Brown, K.QALYs for resource allocation: probably not and certainly not now. Aust J Public Health. 1993;17 (3):278286.Google Scholar