Is pediatric trauma still a surgical disease? Patterns of emergent operative intervention in the injured child.
BACKGROUND
Nonoperative management of many pediatric injuries has generated debate as to whether surgeons must be routinely involved in the early assessment and management of pediatric trauma. This study examines the frequency of operative intervention among injured children and evaluates potential predictors of emergent intervention.


METHODS
Pediatric (age < 18 years) patients were identified from the National Trauma Data Bank. Primary outcome measures were surgical intervention by specialty, time to intervention, and mortality. Prehospital factors were evaluated as predictors of emergent surgical intervention.


RESULTS
Thirty percent of trauma admissions underwent operative intervention, with 57% of these requiring emergent surgery. Patients needing emergent general or neurosurgical intervention were at increased risk of death. Requiring one type of emergent surgical intervention was predictive of needing a second type of emergent procedure. Predictors of emergent general surgical intervention were penetrating mechanism, increasing age, and the presence of shock or coma.


CONCLUSIONS
These data support the continued routine involvement of surgeons in the initial assessment and management of the injured child.
Acierno
Stephanie P
SP
University of Washington, Department of Surgery, Division of General and Trauma Surgery, Harborview Medical Center and the Harborview Injury Prevention and Research Center, Seattle, Washington, USA. saciero@u.washington.edu
Jurkovich
Gregory J
GJ
Nathens
Avery B
AB
D017677:Age Distribution; D002648:Child; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies / Q000453:epidemiology; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D018579:Patient Selection; D010372:Pediatrics / Q000706:statistics & numerical data*; D010819:Physician's Role; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States