Predictors of prolonged emergency department length of stay in severely injured pediatric patients.

BACKGROUND

Prolonged emergency department length of stay (ED-LOS) in severely injured pediatric patients has been associated with adverse clinical outcomes. The determinants of the prolonged length of stay in severely injured pediatric patients remain incompletely understood.

OBJECTIVES

This study aims to identify patient-, injury-, and system-level predictors of prolonged ED-LOS among severely injured pediatric trauma patients. Data for this analysis were obtained from a multicenter trauma registry.

METHODS

We retrospectively analyzed prospectively collected data from the Abu Dhabi Trauma Registry over a 10-year period (2014-2023). Patients included were under 18 years old with an Injury Severity Score (ISS) over 12. We defined prolonged ED-LOS as more than 4 h. We analyzed demographic, clinical, institutional, and temporal variables. Multivariable logistic regression identified independent predictors of prolonged ED-LOS.

RESULTS

We included 874 pediatric patients, with a median ED-LOS of 227.5 min. Prolonged ED-LOS was independently associated with treatment in teaching hospitals (OR 2.25, 95% CI 1.43-3.55), absence of trauma team activation (OR 2.08, 95% CI 1.35-3.22), and non-local nationality (OR 1.66, 95% CI 1.12-2.45). Prolonged ED-LOS was also linked to specific injury mechanisms: road traffic collisions (OR 13.89, 95% CI 1.75-110.00) and low-height falls (OR 13.87, 95% CI 1.68-114.73). Higher injury severity was associated with a decreased likelihood of prolonged ED-LOS (OR 0.94, 95% CI 0.92-0.96). The model showed acceptable discrimination (AUC 0.733).

CONCLUSIONS

Prolonged ED-LOS in severely injured pediatric patients was primarily associated with system-level factors, specifically trauma team activation and hospital characteristics. Additionally, injury mechanisms and demographic factors contributed to prolonged ED-LOS. Optimizing trauma activation protocols and workflow processes, particularly in teaching hospitals, may reduce ED-LOS and improve the efficiency of pediatric trauma care.