[Children and accidents: decreasing mortality, different care].

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.