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Send severely head-injured children to a pediatric trauma center
1Children's Hospital, Penn State University, Milton S. Hershey Medical Center, Hershey 17033, USA. djohns@surg.hmc.psu.edu
Insights
Direct transport of pediatric head injury patients to a trauma center improves survival. Children arriving directly from the accident scene had a lower mortality rate compared to those initially taken elsewhere.
Area of Science:
- Pediatric Neurosurgery
- Trauma Care
- Public Health
Background:
- Head-injured children require specialized neurosurgical care.
- Transport protocols significantly impact patient outcomes.
- Understanding factors influencing survival in pediatric head trauma is critical.
Purpose of the Study:
- To compare the survival rates of pediatric head injury patients based on transport method.
- To identify factors associated with mortality in severe pediatric head trauma.
Main Methods:
- Retrospective analysis of 1,320 head-injured children treated between 1985-1988.
- Categorization of injuries as minor, moderate, or severe.
- Classification of transport as direct (from scene) or indirect (via another hospital).
Main Results:
- Severe head injuries occurred in 98 children (56 direct, 42 indirect transports).
- Indirectly transported children had lower coma scores and higher incidence of abuse.
- Mortality rate for severe head injuries was 26.8% for direct transports versus 50.0% for indirect transports.
Conclusions:
- Direct transport of pediatric head injury patients to a specialized trauma center is associated with significantly better survival rates.
- The transport pathway, not just injury severity or abuse, is a key determinant of outcome.
- Findings support optimizing pre-hospital care and transport logistics for pediatric trauma.
Abstract:
Between 1985 and 1988, a total of 1,320 head-injured children were seen by the neurosurgical service at the Children's Hospital in Washington, D.C. (CHOW). This included 1,095 minor injuries, 127 moderate injuries, and 98 severe injuries. Children brought from the scene of an accident were considered direct transports, whereas those taken to another hospital prior to transfer to CHOW were indirect. Of the children that suffered severe head injuries, 56 were admitted directly to the hospital and 42 indirectly. The indirect group had a higher percentage of children with lower coma scores and abused children. The trauma score was significantly higher in the direct group (9 vs. 7). The mortality rate for severe injuries referred directly from the scene of the accident was 26.8%, and the mortality rate for children referred indirectly was 50.0%. The higher number of abused children in the indirect group did not account for the increase in mortality rate (p = 0.021) in this group. This is the first study to show that children brought directly from the scene of an accident to a well-established pediatric trauma center have a significantly better chance of survival than children transported first to the nearest available hospital.