Highlights
- •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.
Abstract
Introduction
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: August 05, 2022
Accepted:
August 3,
2022
Footnotes
Related Publications: None
Related Abstract Presentations
Atsaidis Z, Fortin M, Guadagno E, Hopkins B, St-Louis E, Poenaru D. Trauma care for severely injured children: a retrospective review and propensity matched analysis. McGill Global Health Night, November 2019. Montreal, Quebec.
Fortin M, Atsaidis Z, Guadagno E, Hopkins B, St-Louis E, Poenaru D. Soins de traumatologie pédiatrique au Québec – Bilan rétrospectif et analyze proportionnelle. 36e Congrès scientifique de médecine d'urgence, October 2019. Montreal, Quebec.
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