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Organization and function of a regional pediatric trauma center: does a system of management improve outcome?
Insights
This study evaluated a pediatric trauma system, showing improved outcomes for injured children. Specialized care and rapid transport led to the lowest reported mortality for pelvic fractures and good recovery for severe head injuries.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Surgical Critical Care
Background:
- Over 1000 children with life-threatening injuries treated since 1975.
- Majority of injuries result from motor vehicle accidents (pedestrian or bicycle).
- Focus on improving care and outcomes for pediatric trauma patients.
Purpose of the Study:
- To assess the effectiveness of a statewide pediatric trauma system.
- To evaluate improvements in care and patient outcomes.
- To analyze specific injury types and their management.
Main Methods:
- Preferential helicopter/ambulance transport to a dedicated Pediatric Trauma Center.
- Initial care by specially trained emergency medical technicians.
- In-hospital management by experienced pediatric and surgical teams.
- Establishment of trauma registry, severity index, and morbidity/mortality rounds.
Main Results:
- Achieved 1.4% mortality for blunt pelvic fractures, the lowest reported.
- For children with prolonged coma (>24 hours), mortality was 38%.
- Intracranial monitoring and aggressive edema control resulted in 88% good recovery among survivors of severe head injury.
Conclusions:
- The established pediatric trauma system demonstrates improved patient care and outcomes.
- Specialized care, rapid transport, and advanced management techniques are crucial.
- The high volume of cases facilitates the development of new trauma management strategies and training.
Abstract:
Since 1975, more than one thousand children with life-threatening injuries have been preferentially transported to our statewide Regional Pediatric Trauma Center by helicopter or city ambulance. Initial care is provided by emergency medical technicians with special instruction in the handling of pediatric trauma. More than half the children admitted to our service were injured in motor vehicle/pedestrian or motor vehicle/bicycle accidents. Have care and outcome improved? This system provides for excellent first aid at the scene and more rapid radio-directed transport to the trauma center where in-hospital management is provided by pediatric and surgical personnel experienced in the treatment of all aspects of childhood trauma. We have organized weekly trauma morbidity and mortality rounds and have established a trauma registry and index of severity. Pelvic fractures from blunt trauma had a mortality in this series of 1.4%, the lowest of any reported experience. Between January 1976 and December 1979, 46 children with coma of longer than 24 hours' duration were treated in the Pediatric Intensive Care Unit. The mortality rate was still high (38%) but employing intracranial monitoring and aggressive control of brain edema, 88% of the survivors had a good recovery without major motor or intellectual defects. The large volume of cases allows for development and evaluation of new techniques in trauma management and invaluable experience in the training of general surgical residents, pediatricians, and emergency physicians.