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Published on: January 15, 2017
Organization of trauma management in French level-1 pediatric trauma centers: A cross-sectional survey
Insights
French pediatric trauma care organization is highly varied, despite most centers having protocols. National guidelines are needed to improve collaboration and outcomes for critically injured children. Keywords: pediatric trauma, trauma care, France, guidelines.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Healthcare organization
Background:
- Limited evidence exists on pediatric trauma care organization in France.
- No national guidelines currently address pediatric trauma management in France.
Purpose of the Study:
- To describe the current organization and management of pediatric trauma patients across French tertiary hospitals.
- To identify variations in care protocols and resource availability.
Main Methods:
- A cross-sectional survey was conducted using a validated electronic questionnaire.
- The survey targeted intensive care physicians in French tertiary hospitals via the GFRUP mailing list.
- Data were collected from 28 centers, representing all French level-1 pediatric trauma centers.
Main Results:
- 75% of pediatric centers have a written local protocol for pediatric trauma care.
- Patient admission locations for severe trauma varied, including adult/pediatric emergency departments and ICUs.
- Pediatric expertise was available in 70% of centers managing trauma with adult physicians, with a typical age cut-off of 3-5 years.
Conclusions:
- Pediatric trauma care organization in France is heterogeneous, despite the presence of local protocols.
- Development of national guidelines is recommended.
- Guidelines should emphasize interprofessional collaboration and hospital facility integration to enhance outcomes for pediatric trauma patients.
Background:
Due to the lack of available evidence on pediatric trauma care organization, no French national guideline has been developed. This survey aimed to describe the management of pediatric trauma patients in France.
Methods:
In this cross-sectional survey, an electronic questionnaire (previously validated) was distributed to intensive care physicians from tertiary hospitals via the GFRUP (Groupe Francophone de Réanimation et Urgences Pédiatriques) mailing list.
Results:
We collected 37 responses from 28 centers with available data, representing 100% of French level-1 pediatric trauma centers. Most of the pediatric centers (n = 21, 75%) had a written local protocol on pediatric trauma care. In most centers (n = 17, 61%), patients with severe trauma could be admitted in various locations, including the adult or pediatric emergency department or the intensive care unit. Usually, the location of the trauma room depended on the patients' age and/or severity of trauma. In 12 centers in which trauma could be managed by adult physicians (n = 12/18, 70%), a physician with pediatric expertise (anesthesiologist or intensive care physician) could be called according to the patient's age or severity of trauma. The cut-off patient age for considering pediatric expertise was mainly 3-5 years (n = 10, 83%).
Conclusion:
Although most French level-1 pediatric trauma centers have a local protocol for pediatric trauma management, organization is very heterogeneous in France. Guidelines should focus on collaboration between professionals and hospital facilities in order to improve outcomes of children with trauma.
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