Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study
Background. Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric e...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-08-01
|
| Series: | Children |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9067/10/8/1377 |
| _version_ | 1797585100341248000 |
|---|---|
| author | Anouk Herren Cameron S. Palmer Markus A. Landolt Markus Lehner Thomas J. Neuhaus Leopold Simma |
| author_facet | Anouk Herren Cameron S. Palmer Markus A. Landolt Markus Lehner Thomas J. Neuhaus Leopold Simma |
| author_sort | Anouk Herren |
| collection | DOAJ |
| description | Background. Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies. Methods. A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis. Results. A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12–15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. <b>Conclusions</b>: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention. |
| first_indexed | 2024-03-11T00:02:04Z |
| format | Article |
| id | doaj.art-3c069ad38b9c454db96f783c46b7f539 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-11T00:02:04Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-3c069ad38b9c454db96f783c46b7f5392023-11-19T00:40:39ZengMDPI AGChildren2227-90672023-08-01108137710.3390/children10081377Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort StudyAnouk Herren0Cameron S. Palmer1Markus A. Landolt2Markus Lehner3Thomas J. Neuhaus4Leopold Simma5Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, SwitzerlandTrauma Service, The Royal Children’s Hospital, Melbourne, VIC 3052, AustraliaDepartment of Psychosomatics and Psychiatry and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, SwitzerlandDepartment of Pediatric Surgery, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, SwitzerlandDepartment of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, SwitzerlandChildren’s Research Center, University Children’s Hospital of Zurich, University of Zurich, CH-8032 Zurich, SwitzerlandBackground. Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies. Methods. A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis. Results. A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12–15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. <b>Conclusions</b>: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention.https://www.mdpi.com/2227-9067/10/8/1377emergency departmenttraumatrauma team activationmajor traumapediatricchild |
| spellingShingle | Anouk Herren Cameron S. Palmer Markus A. Landolt Markus Lehner Thomas J. Neuhaus Leopold Simma Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study Children emergency department trauma trauma team activation major trauma pediatric child |
| title | Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study |
| title_full | Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study |
| title_fullStr | Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study |
| title_full_unstemmed | Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study |
| title_short | Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study |
| title_sort | pediatric trauma and trauma team activation in a swiss pediatric emergency department an observational cohort study |
| topic | emergency department trauma trauma team activation major trauma pediatric child |
| url | https://www.mdpi.com/2227-9067/10/8/1377 |
| work_keys_str_mv | AT anoukherren pediatrictraumaandtraumateamactivationinaswisspediatricemergencydepartmentanobservationalcohortstudy AT cameronspalmer pediatrictraumaandtraumateamactivationinaswisspediatricemergencydepartmentanobservationalcohortstudy AT markusalandolt pediatrictraumaandtraumateamactivationinaswisspediatricemergencydepartmentanobservationalcohortstudy AT markuslehner pediatrictraumaandtraumateamactivationinaswisspediatricemergencydepartmentanobservationalcohortstudy AT thomasjneuhaus pediatrictraumaandtraumateamactivationinaswisspediatricemergencydepartmentanobservationalcohortstudy AT leopoldsimma pediatrictraumaandtraumateamactivationinaswisspediatricemergencydepartmentanobservationalcohortstudy |