[Quality of initial trauma care in paediatrics]

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Pediatric Critical Care

Background:

• Trauma care in Spain lacks specialized centers, limiting healthcare professionals' experience with trauma patients.
• A training program in pediatric trauma was implemented to address this gap.
• The study evaluates the impact of this training on the quality of initial trauma care before PICU admission.

Purpose of the Study:

• To assess the quality of initial care for pediatric trauma patients post-training program implementation.
• To indirectly measure the increase in healthcare professionals trained in trauma care.
• To compare care quality indicators before and after the training initiative.

Main Methods:

• Retrospective review of two cohorts of PICU admissions: pre-training (2001-2004) and post-training (2012-2015).
• Data collected included injury mechanism, attending professional, Glasgow Coma Scale (GCS), and Pediatric Trauma Score (PTS).
• Initial care quality assessed using five indicators: cervical collar use, vascular access, intubation (GCS ≤ 8), gastric decompression (PTS ≤ 8), and adherence to four recommended initial actions.

Main Results:

• A total of 218 patient records were analyzed (105 pre-training, 113 post-training).
• A shift in injury mechanisms was observed, with a decrease in car accidents and an increase in patients from low-complexity hospitals.
• Only cervical collar use improved significantly (17.3% to 32.7%); other quality indicators showed limited or no improvement, with no change in patients receiving no initial actions.

Conclusions:

• The implemented pediatric trauma training program did not translate into significant improvements in initial trauma care quality.
• Limited improvements suggest that training alone is insufficient to ensure systematic application of trauma care principles.
• Additional support measures are necessary to enhance the effectiveness of trauma training and improve patient outcomes.