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Paediatric trauma at an adult trauma centre
Andrew J A Holland1, Alicia M Jackson, Anthony P Joseph
1Department of Paediatric Surgery, Royal North Shore Hospital, The University of Sydney, St Leonards, New South Wales, Australia. andrewh3@chw.edu.au
Insights
Pediatric trauma care in adult trauma centers (ATCs) is safe, with low missed injury rates. Improved referral coordination to pediatric trauma centers (PTCs) can prevent unnecessary transfers.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Surgical Outcomes
Background:
- Childhood trauma is a leading cause of mortality.
- Current outcome measures for pediatric trauma care need enhancement.
- Data on pediatric trauma management in adult trauma centers are limited.
Purpose of the Study:
- To review the care of injured children treated at an adult trauma center.
- To evaluate the safety and effectiveness of adult trauma centers in managing pediatric trauma.
- To assess morbidity and missed injury rates in pediatric trauma patients.
Main Methods:
- Retrospective review of pediatric trauma cases at an adult trauma center.
- Prospective data collection on patients from admission to discharge or transfer.
- Analysis of injury severity, treatment, and outcomes.
Main Results:
- 93 children were treated at the adult trauma center between 1999-2002.
- The median Injury Severity Score was 15; three deaths occurred.
- A low missed injury rate (<1%) and one iatrogenic injury were recorded.
Conclusions:
- Adult trauma centers can safely manage most pediatric trauma cases.
- The missed injury rate was minimal, with no adverse long-term sequelae.
- Enhanced referral coordination to pediatric trauma centers could reduce secondary transfers.
Background:
Trauma in children remains the commonest cause of mortality. The majority of injured children who reach hospital survive, indicating that additional more sensitive outcome measures should be utilized to evaluate paediatric trauma care, including morbidity and missed injury rates. Limited contemporary data have been presented reviewing the care of injured children at an adult trauma centre (ATC).
Methods:
A review was undertaken of injured children who warranted activation of the trauma team, treated within the emergency department of an ATC (Royal North Shore Hospital) situated in the Lower North Shore area of Sydney. Data were collected prospectively and patients followed through to death or discharge from the ATC or another institution to which they had been transferred.
Results:
A total of 93 children were admitted to the ATC between January 1999 and April 2002. Mean age was 9 years 3 months (range 5 weeks-15 years 9 months) and 70% were male. The median injury severity score was 15 (range 1-75) and there were three deaths. Forty-two children were transferred to a paediatric trauma centre (PTC), including three children who had been transferred to the ATC from another hospital. There was one missed injury and one iatrogenic urethral injury.
Conclusions:
The majority of children with trauma were treated safely and appropriately at the ATC. The missed injury rate was < 1% and there were no adverse long-term sequelae of initial treatment. Three secondary transfers could have been avoided by more appropriate coordination of the initial referral to a PTC.
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