title: Paediatric and adolescent trauma care within an integrated trauma system.
abstract: BACKGROUND
  The aim of this study was to establish the profile and outcomes of paediatric major trauma care (PTMC) within an integrated inclusive regionalised trauma system.
  
  
  METHODS
  Prospectively collected data from July 2001 to June 2009 from the Victorian State Trauma Registry of patients aged <18 years were reviewed.
  
  
  RESULTS
  There were 1634 major trauma cases with a median (IQR) age of 13 (6-16) years and 69% were male. The median ISS (IQR) was 18 (16-26). There were 1361 patients treated at a major trauma centre of which 69% (n=943) were treated at the PMTC. Head injury (AIS>2) was the most frequent injury (n=950, 58%). Surgery was required in 39% (n=637) of all cases; 437 patients in the 10-17 year old group and 200 patients in the 0-9 year old group; the mortality was 6.6%. There were 530 patients (32.4%) ventilated in ICU; these had a median ISS (IQR) of 25 (17-34) and mortality of 7.4%. Improvements in risk-adjusted mortality have occurred as the years have progressed [adjusted OR 95% CI: 0.87 (0.76, 0.99)] and being treated at a Level 1 trauma centre was associated with lower adjusted odds of mortality [adjusted OR 95% CI: 0.27 (0.11, 0.68)].
  
  
  CONCLUSIONS
  The establishment of this integrated inclusive regionalised trauma system has been associated with progressively improving risk-adjusted mortality. The relatively low volume of major trauma requiring surgery in the 0-9 year old age group is notable, creating a challenging environment for maintaining skills and institutional preparedness.
authors: Monash University, Department of Epidemiology and Preventive Medicine, Australia. conordeasy@hotmail.com
authors: Conor
authors: C
authors: Deasy
authors: Belinda
authors: B
authors: Gabbe
authors: Cameron
authors: C
authors: Palmer
authors: Franz E
authors: FE
authors: Babl
authors: Catherine
authors: C
authors: Bevan
authors: Joe
authors: J
authors: Crameri
authors: Warwick
authors: W
authors: Butt
authors: Mark
authors: M
authors: Fitzgerald
authors: Rodney
authors: R
authors: Judson
authors: Peter
authors: P
authors: Cameron
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage; D014739:Victoria / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy*