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Distribution, typology and specificity of pediatric polytrauma centers in Italy
Simone Frediani1, Angelo Zarfati1, Pietro Betalli2
1Pediatric General and Urgency Surgery Unit-Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Insights
Pediatric polytrauma care lacks clear guidelines. A national survey revealed varied management practices across Italian hospitals, highlighting the need for standardization and evidence-based protocols to improve patient outcomes.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Healthcare Management
Background:
- Polytrauma, defined by multiple traumatic injuries, presents significant morbidity.
- Current medical and surgical management guidelines for pediatric polytrauma are lacking.
- This study addresses the need for clarity in pediatric polytrauma care standards.
Purpose of the Study:
- To delineate current national standards in pediatric polytrauma patient care.
- To compare management practices between pediatric and hybrid hospitals.
- To assess differences between high- and low-volume trauma centers.
Main Methods:
- A national survey was conducted among senior physicians.
- Participants included members of the Italian Society of Pediatric Surgery and the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care.
- The survey focused on pediatric polytrauma management and institutional characteristics.
Main Results:
- 52 institutions participated; 33% were pediatric hospitals, 67% hybrid.
- 89% had dedicated pediatric emergency departments; 44% had on-call pediatric surgeons.
- Most had pediatric ICUs, 72% had trauma teams, and 94% had polytrauma protocols. No significant differences found in resources.
- High-volume centers reported higher polytrauma incidence.
Conclusions:
- The study offers insights into current pediatric polytrauma management in Italy.
- There is a critical need for standardization, specialized training, and evidence-based guidelines.
- A national trauma registry and further research on volume, training, and guidelines are recommended to improve care.
Introduction:
Polytrauma is defined by the presence of multiple traumatic injuries and poses a significant global health concern due to its associated morbidity. Clear guidelines or recommendations for the medical or surgical management of pediatric polytrauma patients are currently lacking.
Aims:
National Survey of the Management of Paediatric Polytrauma was conducted to clarify and delineate the current national standards in the care paediatric polytrauma patients.
Material And Methods:
We conducted a survey among senior physicians from the Italian Society of Pediatric Surgery and the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care. The survey focused on the management of pediatric polytrauma and compared practices between pediatric and hybrid hospitals, as well as between high- and low-volume centers.
Results:
A national survey of 52 institutions revealed that 33% were paediatric hospitals and 67% were hybrid institutions treating adult patients. We found that 89% of the institutions had a dedicated paediatric emergency department, and 44% had a senior paediatric surgeon on call. Most hospitals had a dedicated paediatric intensive care unit, 72% had a multidisciplinary trauma team, and 94% had an internal protocol for paediatric polytrauma management. We found no significant differences in the number of second-level paediatric emergency departments, availability of paediatric surgeons, multidisciplinary trauma teams, or imaging modalities. High-volume centres had a higher annual incidence of polytrauma than low-volume centres.
Conclusion:
The study provides important insights into the current state of paediatric polytrauma management in the Italian healthcare system. The study emphasised the crucial need for standardisation, specialised training, and the development of evidence-based guidelines. The proposed national trauma registry will be instrumental in facilitating this process and improving the quality of care for paediatric polytrauma patients in Italy. Further research examining the effect of volume, training, and guideline implementation on patient outcomes will significantly enhance this field.
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