title: [Importance of initial management in severe pediatric trauma].
abstract: BACKGROUND
  Trauma is the most frequent cause of mortality in childhood and adolescence and causes almost 25% of admissions in Pediatric Intensive Care Units (PICU). We have evaluated the initial assesment of the severely injured children admitted in our PICU (pre-hospital care).
  
  
  METHODS
  We reviewed the children younger than 16 years admitted in our PICU between January 1996 and December 2002. Prehospital caretakers, transportation after initial evaluation and therapeutic management were analized, using Pediatric Trauma Score (PTS) and Pediatric Risk of Mortality Score (PRISM) as predictors of injury severity and mortality, respectively.
  
  
  RESULTS
  We treated 152 traumatized children in this period, 106 males and 46 females, with a mean age of 7.5 +/- 4.3 years. 116 patients received inmediate medical care with a mean PTS significatively greater than non-medical group (12 children). Non-medical caretakers treated 8.1% of severe trauma (PTS<8). Specialized transporter was inadequated in 7.1% of severe traumatized children. Gastric and vesical tube and spinal inmobilization were accomplished in 50%, specially in children with low PTS and high PRISM. We found a great variability in fluid and drugs administration.
  
  
  CONCLUSIONS
  Although there has been a good evolution in treatment of pediatric trauma, in order to diminish morbidity and mortality it is necessary to identify and correct deficiencies in management, specially during the "golden hour", and train pre-hospital caretakers in pediatric trauma management.
authors.affiliation: Servicios de Cirugía Pediátrica, Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo. dpmata@terra.es
authors.forename: D J
authors.initials: DJ
authors.lastname: Peláez Mata
authors.forename: A
authors.initials: A
authors.lastname: Medina Villanueva
authors.forename: S
authors.initials: S
authors.lastname: García Saavedra
authors.forename: S
authors.initials: S
authors.lastname: Prieto Espuñes
authors.forename: J A
authors.initials: JA
authors.lastname: Concha Torre
authors.forename: S
authors.initials: S
authors.lastname: Menéndez Cuervo
authors.forename: C
authors.initials: C
authors.lastname: Rey Galán
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*