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Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study
Anouk Herren1,2, Cameron S Palmer3,4, Markus A Landolt5,6,7
1Department of Pediatrics, Children's Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland.
Insights
Severely injured children are rare in Swiss pediatric emergency departments, and trauma team activation does not predict injury severity. This highlights the need for specialized training in pediatric trauma management and injury prevention strategies.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Public Health
Background:
- Trauma is a leading cause of childhood death, yet data on severely injured Swiss children are lacking in national registries.
- This study addresses the absence of pediatric trauma data by analyzing trauma activations and patient profiles in a Swiss tertiary pediatric emergency department.
- Findings aim to inform infrastructure, processes, training, and policies for pediatric trauma care.
Purpose of the Study:
- To analyze trauma team activations and the characteristics of critically injured children in a Swiss pediatric emergency department.
- To identify patterns in injury mechanisms and severity for pediatric trauma patients.
- To provide data to guide the development of pediatric trauma care systems in Switzerland.
Main Methods:
- Retrospective analysis of a 2-year prospective resuscitation database.
- Inclusion of critically injured trauma patients under 16 years old.
- Utilized established triage and injury severity scales, with logistic regression for statistical evaluation.
Main Results:
- 82 pediatric trauma patients were analyzed; the 12-15 year age group was most frequent.
- Falls were the most common injury mechanism, while road traffic injuries posed the highest risk for major trauma.
- Trauma team activation occurred in 59.8% of cases, but did not correlate with age, gender, or Injury Severity Score (ISS).
- Major trauma (ISS > 15) occurred in 23.2% of patients, with head injuries being most common.
- Overall mortality was 2.4%.
Conclusions:
- Major trauma cases represent a small fraction of pediatric emergency department patient load.
- Trauma team activation is not a reliable indicator of injury severity in this pediatric cohort.
- Low exposure to high-acuity trauma necessitates continuous learning and simulation for pediatric emergency professionals.
- Prioritizing training in severe pediatric trauma management and implementing injury prevention for common mechanisms are crucial.
Background:
Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies.
Methods:
A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis.
Results:
A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12-15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. Conclusions: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention.
