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First responder performance in pediatric trauma: a comparison with an adult cohort
Sunday Bankole1, Arsenia Asuncion, Steven Ross
1Division of Pediatric Critical Care Medicine, Division of Neonatology Cooper Health Systems, Camden, NJ, USA.
Insights
Prehospital care for pediatric head injuries is suboptimal compared to adults, with children experiencing more complications during endotracheal intubation and requiring more interventions for intravenous access and fluid resuscitation.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Prehospital Services
Background:
- Assessing the quality of prehospital care for injured children compared to adult standards remains a challenge.
- Existing data lacks definitive answers regarding the adequacy of emergency medical services for pediatric patients.
Purpose of the Study:
- To evaluate and compare prehospital emergency medical services for pediatric (<12 years) versus adult (>12 years) head injury patients.
- To determine if emergency medical services providers adequately assess and treat pediatric patients to adult standards.
Main Methods:
- A retrospective 4-year review of 102 pediatric and 99 adult head injury patients (Glasgow Coma Scale score <15) treated at a Level 1 trauma center.
- Analysis of emergency medical service interventions including endotracheal intubation, intravenous access, and fluid resuscitation.
- Documentation of further interventions or complications upon arrival at the trauma center.
Main Results:
- Pediatric patients had significantly more difficulties with endotracheal intubation (69.2% vs. 21.2%) and lower rates of successful intravenous access (65.7% vs. 85.9%) at the scene.
- More children required intravenous access (80.4% vs. 63.6%) and fluid bolus (25.5% vs. 9.1%) upon arrival at the trauma center.
- Injury severity was comparable between pediatric and adult groups based on Glasgow Coma Scale scores.
Conclusions:
- Prehospital care for pediatric head injury patients is suboptimal when compared to adults.
- Deficiencies were noted in endotracheal intubation, peripheral intravenous access, and fluid resuscitation for children.
- Emergency medical services require enhanced protocols for pediatric trauma patients.
Introduction:
Is the prehospital care of injured children comparable with adult standards? This question has been asked repeatedly by many clinicians, yet there are no definite answers.
Objective:
To evaluate the prehospital care provided by first responders to pediatric patients (<12 yrs of age) with head injury compared with the adult group (>12 yrs of age) to determine whether the emergency medical services providers are able to adequately assess the children and provide emergency services comparable with adult standards.
Patients And Methods:
A retrospective 4-yr review of pediatric (n = 102) and adult (n = 99) patients with head injury and Glasgow coma scale score <15 who were treated at a level 1 trauma center. Emergency medical service interventions such as intravenous access, endotracheal intubation, and fluid resuscitation were reviewed. Patients who required further intervention on arrival at the trauma center either from nonperformance of a required procedure or complications arising from such procedures were documented.
Main Results:
There were 102 pediatric and 99 adult patients included in the final analysis. Injury severity based on Glasgow coma scale score was not different between the groups. A total of 91 patients, 52 adults (52.5%) and 39 children (38.2%), needed endotracheal intubation at the scene. Significantly more pediatric patients had problems with intubation, 27 children (69.2%) vs. 11 adults (21.2%), p < .001.Intravenous access was successfully established in 85.9% of adults compared to 65.7% in children at the scene (p = .001). Consequently, on arrival at the trauma center, more children required intravenous access, 80.4% compared with 63.6% for adults (p = .011). As a result, more children (25.5%) required initial or additional fluid bolus at the trauma center compared with adults (9.1%, p = .003).
Conclusions:
Prehospital care of children is suboptimal compared with adults in areas of endotracheal intubation, establishment of peripheral intravenous access, and fluid resuscitation.
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