Prehospital care and survival of pediatric patients with blunt trauma.
BACKGROUND
The aim of this study was to compare the outcome of severe blunt trauma in children receiving prehospital care from either physician-staffed advanced life support (ALS) units, or from basic life support (BLS) units staffed by emergency medical technicians.


METHODS
The records of 288 children with severe blunt trauma who required intensive care in the regional level 1 trauma center or who died from their injuries were analyzed retrospectively. Patients were excluded if resuscitation at the scene was not attempted, if the level of prehospital care was unspecified, or if arrival at the level 1 trauma center was delayed beyond 150 minutes. Seventy-two patients met the inclusion criteria of BLS-, and 49 the criteria of ALS-prehospital care.


RESULTS
A reduced mortality rate (22.4% v 31.9%) was seen in the ALS group, which was more apparent in a "salvageable but high-risk" subgroup, characterized by Glasgow Coma of Scale 4 through 8, Pediatric Trauma Score of 0 through 5, and Injury Severity Score (ISS) of 25 through 49. However, a statistically significant difference was only seen when trauma severity was evaluated by the ISS.


CONCLUSIONS
An improved outcome in children with severe blunt trauma has been demonstrated when prehospital care is provided by physician-staffed ALS units compared with BLS units.
Department of Anaesthesia, University of Helsinki, Finland.
P
P
Suominen
C
C
Baillie
A
A
Kivioja
R
R
Korpela
R
R
Rintala
T
T
Silfvast
K T
KT
Olkkola
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D010820:Physicians; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*