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[Children and accidents: decreasing mortality, different care]
I Stompedissel1, J W Coebergh, J C Molenaar
1Academisch Ziekenhuis Rotterdam-Sophia Kinderziekenhuis, Kinderchirurgische groep.
Insights
Severe childhood injuries decreased, yet Intensive Care Unit admissions rose, indicating a shift in referral patterns. This suggests a need for centralized pediatric trauma care to maintain physician skills.
Area of Science:
- Pediatric Surgery
- Epidemiology
- Trauma Care Research
Background:
- The University Hospital of Rotterdam studied trauma care for children with severe injuries.
- Regional standardized mortality rates and clinical prevalence of trauma injuries declined significantly between 1979 and 1986.
Purpose of the Study:
- To explore the demand for pediatric trauma care facilities.
- To analyze mortality, morbidity, and trauma care patterns in children with severe injuries.
- To assess the impact of changing injury patterns and referral practices on trauma care services.
Main Methods:
- Retrospective analysis of mortality, morbidity, and hospital admission data for pediatric trauma patients.
- Comparison of regional and national epidemiological data.
- Evaluation of Intensive Care Unit (ICU) admission trends for severely injured children.
Main Results:
- A 40% decline in standardized mortality rate and a decrease in trauma injury prevalence were observed.
- Hospital admissions for childhood injuries stabilized, but ICU admissions for severe injuries increased by 46%.
- Increased ICU admissions were primarily from outside the immediate Rotterdam area, indicating a developing referral pattern.
Conclusions:
- A shift in referral patterns for severely injured children has emerged in the south-west of The Netherlands.
- Decreasing severe childhood injuries coupled with increasing care complexity raises concerns about skill maintenance.
- Centralization of pediatric trauma care is recommended to ensure continued expertise and optimal patient outcomes.
Abstract:
In order to explore the demand for trauma care facilities for children with severe injuries in the University Hospital of Rotterdam, the departments of Paediatric Surgery and Epidemiology initiated a study of mortality, morbidity and patterns of trauma care. The standardized mortality rate in the region declined by 40% between 1979 and 1986, as did the clinical prevalence of trauma injuries, expressed by the number of days spent in hospital per 100,000 children. This was in agreement with the national epidemiological data. The number of hospital admissions for childhood injuries in the University Hospital of Rotterdam stabilized in recent years, which may be considered a relative increase. Moreover the number of children with severe injuries admitted to Intensive Care Units increased by 46%, which was mainly due to Intensive Care admissions of children living outside Rotterdam. Obviously, another pattern of referral of these patients has developed in the south-west of The Netherlands. The decrease of the number of severe injuries in childhood together with the complexity of trauma care and the increasing number of physicians raises questions on the maintenance of skills. This is an argument for centralization of trauma care for severely injured children, which to some extent has already been implemented in this region.