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Paediatric Care in a Combined Trauma Centre - A Retrospective Cohort Study Examining Major Trauma Processes and
Daniel Pasquale Cinelli1, Raksheel Chand2, Joel D'Souza3
1Department of Surgery, Health New Zealand/Te Whatu Ora, Christchurch, New Zealand.
Insights
This study compared adult and pediatric trauma care at Christchurch Hospital. Pediatric patients experienced shorter CT scan times and emergency department stays, showing efficient care within the current model.
Area of Science:
- Trauma surgery
- Emergency medicine
- Paediatric critical care
Background:
- Paediatric and adult trauma management differ due to anatomical and physiological variations.
- Christchurch Hospital operates as a combined trauma center with a specialized pediatric service.
- A system analysis was conducted to evaluate the outcomes of this integrated trauma service.
Purpose of the Study:
- To compare outcomes between adult and pediatric major trauma patients.
- To assess the efficiency of the nested pediatric trauma service within a predominantly adult hospital.
- To establish baseline characteristics of the trauma service for future research.
Main Methods:
- Retrospective analysis of major trauma patients (Injury Severity Score > 12).
- Data collected from Christchurch Hospital Emergency Department between June 2016 and November 2021.
- Comparison of outcomes including time to CT, length of stay, and mortality rates.
Main Results:
- 1594 adult and 77 pediatric patients were analyzed.
- Pediatric patients had significantly shorter median times to CT (83 min vs. 96 min) and ED length of stay (124 min vs. 282 min).
- Mortality rates were 4% for pediatric and 8% for adult patients (p=0.06).
Conclusions:
- The study establishes baseline data for the Christchurch Hospital trauma service.
- The current nested pediatric trauma service model demonstrates efficient care delivery for children.
- Further research is recommended to define clinical demand and characterize pediatric-specific trauma interventions.
Aim:
Priorities in the assessment and management of major trauma between paediatric and adult patients vary due to clinically relevant differences in anatomy and physiology. Christchurch Hospital is a combined trauma centre, where-in a paediatric trauma service is nested into a predominantly adult hospital, providing specialist paediatric surgical care to the South Island of New Zealand. A system analysis comparing outcomes between adult and paediatric patients was undertaken to assess this service.
Methods:
A retrospective analysis comparing outcomes between all paediatric and adult major trauma patients (Injury Severity score > 12) who presented to Christchurch Hospital Emergency Department (ED) between June 2016 and November 2021.
Results:
A total of 1594 adult (median age 51, IQR 33-67) and 77 paediatric (median age 11, IQR 7-14) patients were identified. Median time to CT was significantly shorter in paediatric patients compared to adults (83 min vs. 96 min, p = 0.05). Similarly, the ED length of stay was significantly shorter in paediatric patients (124 min vs. 282 min, p < 0.001). The paediatric and adult mortality rates were 4% and 8% respectively (p value 0.06).
Conclusions:
These results serve to establish baseline characteristics of our trauma service and demonstrate efficient paediatric trauma care delivery within our current nested paediatric trauma service model. Further research may help delineate clinical demand for population-specific trauma services and characterise trauma-specific interventions in the paediatric population.
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