Holland Andrew J A, Jackson Alicia M, Joseph Anthony P
Department of Paediatric Surgery, Royal North Shore Hospital, The University of Sydney, St Leonards, New South Wales, Australia.
ANZ J Surg. 2005 Oct;75(10):878-81. doi: 10.1111/j.1445-2197.2005.03553.x.
Trauma in children remains the commonest cause of mortality. The majority of injured children who reach hospital survive, indicating that additional more sensitive outcome measures should be utilized to evaluate paediatric trauma care, including morbidity and missed injury rates. Limited contemporary data have been presented reviewing the care of injured children at an adult trauma centre (ATC).
A review was undertaken of injured children who warranted activation of the trauma team, treated within the emergency department of an ATC (Royal North Shore Hospital) situated in the Lower North Shore area of Sydney. Data were collected prospectively and patients followed through to death or discharge from the ATC or another institution to which they had been transferred.
A total of 93 children were admitted to the ATC between January 1999 and April 2002. Mean age was 9 years 3 months (range 5 weeks-15 years 9 months) and 70% were male. The median injury severity score was 15 (range 1-75) and there were three deaths. Forty-two children were transferred to a paediatric trauma centre (PTC), including three children who had been transferred to the ATC from another hospital. There was one missed injury and one iatrogenic urethral injury.
The majority of children with trauma were treated safely and appropriately at the ATC. The missed injury rate was < 1% and there were no adverse long-term sequelae of initial treatment. Three secondary transfers could have been avoided by more appropriate coordination of the initial referral to a PTC.
儿童创伤仍是最常见的死亡原因。大多数送达医院的受伤儿童存活下来，这表明应采用更敏感的额外结局指标来评估儿科创伤护理，包括发病率和漏诊率。目前关于成人创伤中心（ATC）对受伤儿童护理情况的当代数据有限。
对在悉尼下北岸地区一家ATC（皇家北岸医院）急诊科接受治疗、需要启动创伤团队的受伤儿童进行了回顾性研究。前瞻性收集数据，并对患者进行随访，直至其死亡、从ATC出院或转至其他机构。
1999年1月至2002年4月期间，共有93名儿童入住ATC。平均年龄为9岁3个月（范围5周 - 15岁9个月），70%为男性。损伤严重程度评分中位数为15（范围1 - 75），有3例死亡。42名儿童被转至儿科创伤中心（PTC），其中包括3名从其他医院转至ATC的儿童。有1例漏诊损伤和1例医源性尿道损伤。
大多数创伤儿童在ATC得到了安全、恰当的治疗。漏诊率<1%，初始治疗无不良长期后遗症。通过更合理地协调最初转诊至PTC，可避免3次二次转诊。
