Paediatric trauma at an adult trauma centre.
BACKGROUND
Trauma in children remains the commonest cause of mortality. The majority of injured children who reach hospital survive, indicating that additional more sensitive outcome measures should be utilized to evaluate paediatric trauma care, including morbidity and missed injury rates. Limited contemporary data have been presented reviewing the care of injured children at an adult trauma centre (ATC).


METHODS
A review was undertaken of injured children who warranted activation of the trauma team, treated within the emergency department of an ATC (Royal North Shore Hospital) situated in the Lower North Shore area of Sydney. Data were collected prospectively and patients followed through to death or discharge from the ATC or another institution to which they had been transferred.


RESULTS
A total of 93 children were admitted to the ATC between January 1999 and April 2002. Mean age was 9 years 3 months (range 5 weeks-15 years 9 months) and 70% were male. The median injury severity score was 15 (range 1-75) and there were three deaths. Forty-two children were transferred to a paediatric trauma centre (PTC), including three children who had been transferred to the ATC from another hospital. There was one missed injury and one iatrogenic urethral injury.


CONCLUSIONS
The majority of children with trauma were treated safely and appropriately at the ATC. The missed injury rate was < 1% and there were no adverse long-term sequelae of initial treatment. Three secondary transfers could have been avoided by more appropriate coordination of the initial referral to a PTC.
Holland
Andrew J A
AJ
Department of Paediatric Surgery, Royal North Shore Hospital, The University of Sydney, St Leonards, New South Wales, Australia. andrewh3@chw.edu.au
Jackson
Alicia M
AM
Joseph
Anthony P
AP
D000293:Adolescent; D000367:Age Factors; D001315:Australia; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000628:therapy; D010360:Patient Transfer; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality / Q000628:therapy*