Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-25T09:02:27.891Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcome in an Urban Pediatric Trauma System with Unified Prehospital Emergency Medical Services Care

Published online by Cambridge University Press:  28 June 2012

Michael J. VanRooyen ,
Edward P. Sloan ,
John A. Barrett ,
Robert F. Smith  and
Hernan M. Reyes
Michael J. VanRooyen*
Affiliation:
Department of Emergency Medicine, University of Illinois College of Medicine, Chicago, Illinois
Edward P. Sloan
Affiliation:
Department of Emergency Medicine, University of Illinois College of Medicine, Chicago, Illinois Division of Trauma Surgery, Cook County Hospital, Chicago, Illinois
John A. Barrett
Affiliation:
Division of Trauma Surgery, Cook County Hospital, Chicago, Illinois Department of Surgery, University of Illinois College of Medicine, Chicago, Illinois
Robert F. Smith
Affiliation:
Division of Trauma Surgery, Cook County Hospital, Chicago, Illinois Chicago Department of Health, Chicago, Illinois
Hernan M. Reyes
Affiliation:
Department of Surgery, University of Illinois College of Medicine, Chicago, Illinois Department of Surgery, Cook County Hospital, Chicago, Illinois
*
University of Illinois College of Medicine, Program in Emergency Medicine, Room 618, M/C 724, 1853 West Polk Street, Chicago, IL 60612USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Hypothesis:

Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.

Population:

Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.

Methods:

Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.

Results:

Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.

Conclusions:

Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.

Keywords

Glasgow Coma ScaleinjurypediatricoutcomePediatric Trauma Scaletrauma systemstriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 1 , March 1995 , pp. 19 - 23
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at the National Conference on Pediatric Trauma, September 1992, Indianapolis, Indiana

References

1. Gallagher, SS, Finison, K, Guyer, B, et al. : The incidence of injuries among 87,000 Massachusetts children and adolescents. Am J Public Health 1984;74:1340–1347.Google Scholar
2. Gratz, RR: Accidental injury in childhood: A literature review on pediatric trauma. J Trauma 1979;19:551–555.CrossRefGoogle ScholarPubMed
3. Guyer, B, Ellers, B: The causes, impact and preventability of child-hood injuries in the United States: The magnitude of childhood injuries, an overview. Am J Dis Child 1988;144:649–652.CrossRefGoogle Scholar
4. Haller, JA: Pediatric trauma, the No.1 killer of children. JAMA 1983;249:47.Google Scholar
5. Ramenofsky, ML., Ramenofsky, MB, Jurkovich, GI, et al. : The predicuve validity of the pediatric trauma score. J Traumal 1988;28:1038–1042.CrossRefGoogle ScholarPubMed
6. Tepas, JJ, Mollitt, DL, Talbert, JL, et al. : The pediatric trauma score as a predictor of injury severity in the injured child. J Ped Surg 1987;22:14–18.CrossRefGoogle ScholarPubMed
7. Tepas, JJ, Ramenofsky, ML, Mollitt, DL, et al. : The pediatric trauma score as a predictor of injury severity: An objective assessment. J Trauma 1988;28:425–429.CrossRefGoogle ScholarPubMed
8. Haller, JA, Shorter, N, Miller, D, et al. : Organization and function of a regional pediatric trauma center: Does a system of management improve outcome? J Trauma 1983;23:691–696.CrossRefGoogle ScholarPubMed
9. Jaffe, D, Wesson, D: Emergency management of blunt trauma in children. N Engl J Med 1991;324:1477–1482.Google Scholar
10. Nakayama, DK, Saintz, EW. Gardnew, MJ, et al. : Quality assessment in the pediatric trauma care system. J Ped Surg 1988;24:159–162.Google Scholar
11. Ramenofsky, ML, Luterman, A, Quidlen, E, et al. : Maximum survival in pediatric trauma: The ideal system. J Trauma 1984;24:818.Google Scholar
12. Colombani, PM, Buck, JR, Ramenofsky, ML, et al. : One year experience in a regional pediatric trauma center. J Ped Surg 1985;20:8–13.CrossRefGoogle Scholar
13. Tepas, JJ, DiScala, C, Ramenofsky, ML, et al. : Mortality and head injury: The pediatric perspective. J Ped Surg 1990;25:92–96.Google Scholar
14. Smith, RF, Frateschi, F, Sloan, EP, et al. : The impact of volume on outcome in seriously injured trauma patients: Two years experience of the Chicago trauma system. J Trauma 1990;30:1066–1076.Google Scholar
15. Chan, BSH, Walker, PJ, Cass, DT: Urban trauma: An analysis of 1,116 pediatric cases. J Trauma 1989;29:1540–1547.Google Scholar
16. Seidel, JS, Hornbein, M, Yoshiyama, K, et al. : Emergency medical services and the pediatric patient: Are the needs being met? Pediatrics 1984;73:769–724.CrossRefGoogle ScholarPubMed
17. Rouse, TM, Eichelberger, MR: Trends in pediatric trauma management. Surg Clin North Amer 1992;72:1347–1364.Google Scholar
18. Sloan, EP, Koenigsberg, MD, Nolan, J, et al. : EMS field triage criteria in an urban setting. Ann Emerg Med 1988;17:426.Google Scholar
19. Eichelberger, MR, Bowman, LM, Sacco, WJ, et al. : Trauma score vs revised trauma score in TRISS to predict outcome in children with blunt trauma. Ann Emerg Med 1989;18:939–942.Google Scholar
20. Eichelberger, MR, Gotschall, CS, Sacco, WJ, et al. : A comparison of the trauma score, the revised trauma score, and the pediatric trauma score. Ann Emerg Med 1989;18:1053–1058.CrossRefGoogle ScholarPubMed