Investigating moderate to severe paediatric trauma in the Auckland region
Louise Couch1, Kim Yates, Richard Aickin
1North Shore Hospital, Auckland, New Zealand. loucouch@xtra.co.nz
Insights
This study found no significant differences in pediatric trauma patient severity or outcomes between two emergency departments (EDs). This suggests patients are triaged to the nearest ED, even with a specialized trauma center available.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Health Services Research
Background:
- Paediatric trauma management requires efficient triage to appropriate emergency departments (EDs).
- Understanding patient distribution and severity across different EDs is crucial for resource allocation and care quality.
- Auckland has both a general paediatric ED (KidzFirst) and a tertiary paediatric trauma center (Starship Children's ED).
Purpose of the Study:
- To compare paediatric patients with moderate to severe trauma admitted from two distinct EDs.
- To analyze differences in demographics, presentation patterns, injury mechanisms, severity scores, interventions, and outcomes.
- To assess the impact of ED location on trauma patient management and severity.
Main Methods:
- Retrospective cohort study of paediatric patients with Injury Severity Score (ISS) > 9.
- Data collected from Starship Children's ED and KidzFirst ED between May 2003 and April 2004.
- Statistical analysis included descriptive statistics, Mann-Whitney U-test, chi-squared test, and Fisher's exact test.
Main Results:
- 82 children met inclusion criteria (ISS > 9), with 42 from KidzFirst ED and 40 from Starship Children's ED.
- No statistically significant differences were found in ISS, Paediatric Trauma Score (PTS), Glasgow Coma Score (GCS), ventilator hours, or length of stay.
- Patient demographics and injury characteristics were comparable between the two EDs.
Conclusions:
- There are no discernible differences in the volume or severity of paediatric trauma patients admitted from the two Auckland EDs.
- Findings suggest that patients are likely triaged to the closest ED, irrespective of the availability of a tertiary paediatric trauma center.
- This highlights the importance of local ED protocols in managing paediatric trauma cases.
Objective:
To investigate differences between paediatric patients with moderate to severe trauma admitted from two paediatric ED, with respect to: demographics, patterns of presentation, mechanism of injury, injury severity scores (ISS), interventions and outcome.
Method:
Retrospective cohort study. Moderate to severe trauma was defined as ISS>9. Paediatric patients admitted to hospital via Starship Children's Emergency or KidzFirst ED, with trauma from 1 May 2003 to 30 April 2004, with ISS>9 were identified using multiple databases. The charts were reviewed and data collected included: demographics, hospital of first presentation, diagnoses, ISS, Paediatric trauma score (PTS), Glasgow coma score (GCS), ventilator hours, length of admission, survival and discharge destination. Descriptive statistics with 95% confidence intervals, Mann-Whitney U-test, chi2-test and Fisher's exact test were used as appropriate.
Results:
A total of 393 children with moderate to severe trauma were identified using initial search strategies. Of these, 82 children met the inclusion and exclusion criteria for the study; 42 children were admitted via KidzFirst ED and 40 via Starship Children's ED. There was no statistically significant difference in ISS (P=0.86), PTS (P=0.11), GCS (P=0.62), hours on a ventilator (P=0.28) and length of stay (P=0.87) between children admitted from Starship or KidzFirst ED.
Conclusion:
This study suggests that there are no differences in the numbers or severity of paediatric trauma patients admitted from the Starship and KidzFirst ED. This indicates triage is to the closest ED despite having a tertiary referral centre for paediatric trauma available in Auckland City.
