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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
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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

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Footnotes

*

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

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