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Pediatric trauma: need for surgical management
C R Kaufmann1, F P Rivara, R V Maier
1Department of Surgery, University of Washington, Seattle.
Insights
Pediatric trauma surgery is essential, even for less severe injuries. This study shows a high rate of operative intervention is needed for injured children, challenging proposals for non-surgical primary care.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Pediatric Critical Care
Background:
- A proposal suggests pediatricians manage resuscitation and triage, with surgery initiated only via consultation.
- This approach questions the necessity of immediate surgical involvement in pediatric trauma care.
Purpose of the Study:
- To assess the actual need for operative intervention in pediatric trauma patients.
- To evaluate the rate of surgical procedures required across different injury severities in children.
Main Methods:
- A consecutive series of 376 children under 15 admitted to a regional trauma center was reviewed.
- Injury severity was assessed using the Revised Trauma Score (RTS).
- Data on operations performed and mortality rates were analyzed.
Main Results:
- 194 children underwent 254 operations, with an overall mortality of 7.2%.
- Children with persistent hemodynamic instability had a 73% mortality rate.
- Operative intervention was required in 79% of severely injured (RTS ≤ 6), 42% of moderately injured (6 < RTS < 12), and 14% of minimally injured (RTS = 12) children.
Conclusions:
- The need for operative management in pediatric trauma is significant across all injury severities.
- Even children with "minimally" severe injuries may require surgical intervention.
- Findings support the critical role of surgical consultation and intervention in pediatric trauma care.
Abstract:
A recent proposal by some pediatricians is that they be primarily responsible for resuscitation and triage of injured children with surgical care being initiated only through consultation. To assess the need for operative intervention, a consecutive series of 376 children less than 15 years of age admitted to a regional trauma center was examined, in which 194 children had 254 operations. Mortality was 7.2%. Twenty-two children who presented with persistent hemodynamic instability (sys. BP less than 90 mm Hg) had a mortality of 73%. Children were divided into three severity groups based on the Revised Trauma Score (RTS). Of the severely injured children (RTS less than or equal to 6), 79% required emergent operative intervention; 42% and 14%, respectively, required emergent operation in the moderately (6 less than RTS less than 12) and minimally (RTS = 12) injured groups. The need for operative management is great, even in "minimally" injured children.