Pediatric major resuscitation--respiratory compromise as a criterion for mandatory surgeon presence.
The American College of Surgeons Committee on Trauma has indicated that there are minimum criteria for a trauma surgeon to respond to a major resuscitation (MR) within 15 minutes. These criteria have been required for children without significant data to support their validity. Our hypothesis is that prehospital intubation/respiratory compromise (IRC) as a criterion to define an MR will be an accurate predictor.


METHODS
The trauma registry of a level I trauma center was used for data collection of age, injury severity score (ISS), IRC, mortality, hospital days, intensive care unit (ICU) days, and emergency operations. Chi2 with Yates correction and Mann-Whitney rank-sum testing was used for statistical analysis expressed as mean +/- SEM.


RESULTS
One hundred eighteen patients were encoded as MR. Forty patients had prehospital IRC and 78 patients did not. There were statistically significant differences seen in ISS, ICU length of stay, and mortality (P < .001). Forty-five percent of patients with IRC died. None of the patients without IRC died.


CONCLUSIONS
Injured children with prehospital IRC are significantly more likely to die, have a higher ISS, and a longer ICU length of stay. Prehospital respiratory distress in injured children in our trauma system is a reasonable criterion to define an MR in children.
Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
Barish H
BH
Edil
David W
DW
Tuggle
Susan
S
Jones
Roxie
R
Albrecht
Ann
A
Kuhn
P Cameron
PC
Mantor
Nikola K
NK
Puffinbarger
D002648:Child; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D013502:General Surgery; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D010372:Pediatrics / Q000592:standards*; D012131:Respiratory Insufficiency / Q000628:therapy; D012151:Resuscitation / Q000592:standards*; D012189:Retrospective Studies; D014193:Trauma Centers; D014194:Traumatology; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality / Q000628:therapy*