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Maximum survival in pediatric trauma: the ideal system
Insights
Analyzing 100 pediatric trauma deaths revealed that 53% had survival potential. Improving emergency medical services (EMS) and trauma system care, especially in identification and field treatment, could reduce pediatric trauma mortality.
Area of Science:
- Pediatric Trauma Care
- Emergency Medical Services (EMS)
- Trauma System Analysis
Background:
- Pediatric trauma remains a significant cause of mortality in children.
- Evaluating the effectiveness of emergency medical services (EMS) and trauma systems is crucial for improving outcomes.
- Understanding where care failures occur is key to optimizing pediatric trauma survival.
Purpose of the Study:
- To analyze the survival potential of pediatric trauma deaths.
- To identify errors in care within an established EMS/Trauma system.
- To determine the impact of system errors on pediatric trauma mortality.
Main Methods:
- Retrospective analysis of 100 consecutive pediatric trauma deaths (0.01-18 years).
- Evaluation of paramedic run sheets, ER records, hospital records, and autopsy reports.
- Categorization of deaths into non-survivable and potentially survivable groups based on injury severity and care quality.
Main Results:
- 47% of cases had non-survivable injuries.
- 53% of cases had potential for survival with optimal EMS/Trauma system function.
- Errors in care were identified in potentially salvageable cases: 79% in identification, 36% in field treatment, 23% in transport, and 17% in definitive care.
Conclusions:
- A significant proportion of pediatric trauma deaths are potentially survivable.
- System errors, particularly in the identification and initial management phases, contribute to preventable mortality.
- Optimizing EMS/Trauma system function and addressing identified errors can reduce pediatric trauma mortality.
Abstract:
One hundred consecutive pediatric trauma deaths (0.01-18 yrs) were analyzed for their survival potential in an optimally functioning EMS/Trauma system in Mobile, Alabama (1980-1982). Thorough evaluation of all phases of care by paramedic run sheets, ER records, hospital records, and autopsy reports, revealed that 47/100 victims could have never survived due to the extreme nature of their injuries, and 53/100 victims had the potential of surviving if the EMS/Trauma system functioned optimally. Errors in care were identified in those cases deemed potentially salvageable. Identification phase errors were found in 79% of potentially salvageable victims. Field treatment errors occurred in 36%, transport errors in 23%, and definitive care errors in 17% of those considered to be potentially salvageable. By evaluating where in an EMS/Trauma system errors occur and then by correcting those errors, it should be possible to minimize the mortality rate in pediatric trauma.