title: The effect of regional trauma networks on paediatric trauma care in an integrated adult service.
abstract: OBJECTIVE
  Our study analyzes the impact of becoming a major trauma centre (MTC) on paediatric trauma workload in a centre outside a major city without specialist paediatric surgical services.
  
  
  METHODS
  Paediatric 'trauma calls' presenting between 1 April 2010 and 31 March 2013 were retrospectively reviewed. As our centre became an MTC on 1 April 2012, our study population was split into 'pre-MTC' and 'post-MTC' groups. Patient demographics, mechanism of injury, patient outcome, Injury Severity Score and results of radiological investigations were recorded.
  
  
  RESULTS
  There were 132 paediatric trauma calls, with a 72% annual increase post-MTC. More children with minor injuries, according to the Injury Severity Score, were seen post-MTC (47.5 vs. 29.6%). Although the proportion of patients undergoing a CT scanning remained static, the actual number increased and a higher proportion were normal in the post-MTC group (72.9 vs. 52.4%). This contributed to a higher proportion of patients being discharged home directly from the emergency department post-MTC (47.5 vs. 36.6%). Practice moved away from targeted CT scanning, in favour of trauma scanning post-MTC.
  
  
  CONCLUSIONS
  The implementation of a regional trauma network has led to a rise in paediatric trauma cases. Paediatric trauma patients tend to be less severely injured, but the proportion undergoing CT scanning has remained the same, and these scans are more likely to be normal. A more rational approach for imaging of paediatric trauma patients is required to reduce the potentially harmful effects of exposure to ionizing radiation, and criteria for implementing trauma calls in children should be reconsidered.
authors.affiliation: Departments of aTrauma and Orthopaedics bRadiology, University Hospitals Coventry & Warwickshire, Coventry, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Jordan
authors.forename: Daniel
authors.initials: D
authors.lastname: Westacott
authors.forename: Hiten
authors.initials: H
authors.lastname: Patel
authors.forename: Giles
authors.initials: G
authors.lastname: Pattison
mesh_terms: D000367:Age Factors; D002648:Child; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012041:Regional Medical Programs / Q000458:organization & administration / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000628:therapy