title: Paediatric trauma systems and their impact on the health outcomes of severely injured children: An integrative review.
abstract: BACKGROUND
  Injury is a leading cause of death and disability for children. Regionalised trauma systems have improved outcomes for severely injured adults, however the impact of adult orientated trauma systems on the outcomes of severely injured children remains unclear.
  
  
  OBJECTIVE
  This research aims to identify the impact of trauma systems on the health outcomes of children following severe injury.
  
  
  METHODS
  Integrative review with data sourced from Medline, Embase, CINAHL, Scopus and hand searched references. Abstracts were screened for inclusion/exclusion criteria with fifty nine articles appraised for quality, analysed and synthesised into 3 main categories.
  
  
  RESULTS
  The key findings from this review include: (1) a lack of consistency of prehospital and inhospital triage criteria for severely injured children leading to missed injuries, secondary transfer and poor utilisation of finite resources; (2) severely injured children treated at paediatric trauma centres had improved outcomes when compared to those treated at adult trauma centres, particularly younger children; (3) major causes of delays to secondary transfer are unnecessary imaging and failure to recognise the need for transfer; (4) a lack of functional or long term outcomes measurements identified in the literature.
  
  
  CONCLUSIONS
  Research designed to identify the best processes of care and describe the impacts of trauma systems on the long term health outcomes of severely injured children is required. Ideally all phases of care including prehospital, paediatric triage trauma criteria, hospital type and interfacility transfer should be included, focusing on timeliness and appropriateness of care. Outcome measures should include long term functional outcomes in addition to mortality.
authors.affiliation: Sydney Nursing School, The University of Sydney, NSW, Australia; Wollongong Hospital, Wollongong, NSW, Australia. Electronic address: amy.mccarthy@sydney.edu.au.
authors.forename: Amy
authors.initials: A
authors.lastname: McCarthy
authors.affiliation: Sydney Nursing School, The University of Sydney, NSW, Australia; St George Hospital, Kogarah, NSW, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Curtis
authors.affiliation: Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia; The Children's Hospital at Westmead Burns Research Institute, NSW, Australia.
authors.forename: Andrew J A
authors.initials: AJ
authors.lastname: Holland
mesh_terms: D001315:Australia / Q000453:epidemiology; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D014193:Trauma Centers / Q000706:statistics & numerical data; D014218:Triage / Q000592:standards; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
keywords: Ambulances; Children; Emergency medical services; Injury; Outcomes; Trauma centres; Trauma system; Triage