Management of severely injured children in road accidents in France: impact of the acute care organization on the outcome.
OBJECTIVE
To examine the impact of acute care management on outcome in children severely injured in road accidents.


METHODS
Prospective follow-up study conducted in 12 French pediatric intensive care units over a 24-month period.


METHODS
Excluding those in refractory shock or in brain death at admission, a total of 125 children aged <17 years admitted to the pediatric intensive care unit with severe trauma (Injury Severity Score > or =16) were included.


RESULTS
Intracranial pressure (ICP) monitoring and admission into a trauma resuscitation room (TRR) were used as proxy markers for the center management aggressiveness. Centers which admitted to TRR and monitored ICP when indicated in >75% of cases were called aggressive centers. Children with an ICP monitoring indication admitted to a TRR and monitored, as well as those without an indication treated in a TRR, were judged appropriately managed. A poor outcome at pediatric intensive care unit discharge was defined as a difference between the baseline and discharge pediatric overall performance category above 3, or a hospital death. Children with traumatic brain injury appropriately managed in a less-aggressive center were more likely to have a poor outcome than those appropriately managed in an aggressive center (odds ratio 7.56, 95% confidence interval 1.5-38.4), after adjustment for severity, age, and type of road user.


CONCLUSIONS
The management in a more aggressive center for children admitted to TRR and monitored for ICP, when indicated, is associated with a better outcome. This could be explained by a more extensive experience in trauma management.
Javouhey
Etienne
E
Service de réanimation et d'urgences pédiatriques, Hôpital Femme-Mère-Enfant, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France. etienne.javouhey@chu-lyon.fr
Guérin
Anne-Céline
AC
Martin
Jean-Louis
JL
Floret
Daniel
D
Chiron
Mireille
M
D000046:Academic Medical Centers / Q000458:organization & administration; D000063:Accidents, Traffic; D001926:Brain Death; D001930:Brain Injuries / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D007427:Intracranial Pressure; D008297:Male; D011446:Prospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*