Regional review of blunt trauma in children

Seventy-five severely injured children (Injury Severity Score greater than 15 or death) were identified during a 1-year prospective audit of all severe trauma in a single region. Fourteen children were admitted primarily to the regional children's hospital, comprising 0.2 per cent of that accident and emergency department workload. Paediatric trauma admissions to the 15 district general hospitals averaged 3.1 children per hospital per year or 0.007 per cent of the accident and emergency department attendances. There were 38 deaths (51 per cent), of which 15 occurred before admission to hospital. Significant deficiencies in acute management were identified at both types of hospital. There is a need to improve trauma management of children at tertiary care level and district general hospitals by developing trauma management protocols. The low number of severely injured children presenting to the district general hospitals suggests the need for a regional trauma system.