Centre for Maternal and Child Enquiries (CMACE), Chiltern Court, 188 Baker Street, London NW1 5SD, UK.
Emerg Med J. 2012 Apr;29(4):309-15. doi: 10.1136/emj.2011.112110. Epub 2011 May 23.
To assess how child emergency department (ED) attendances are distributed between hospitals across England, Wales and Northern Ireland and how care is organised for children with a head injury.
A cross-sectional survey was performed of the 245 hospitals in England Wales, Northern Ireland and the Crown Dependencies (Channel Islands and Isle of Man) which were eligible to participate in the enquiry from September 2009 to April 2010. The survey covered hospital details, departments and procedures, ED activity, imaging, admission and discharge procedures, referral and transfer, documentation, training and audit, information and advice, and non-accidental head injuries.
64% of hospitals have an established pathway for management of head injured children. Not infrequently hospitals asserting designation as specialist trauma or specialist neurosurgical centres do not offer an intensive care service for children. 82% of child ED attendances are to hospitals that would not care for a critically ill child on-site. Hospitals that do offer such care are much more likely to have children's trained staff available in the ED. They are also more likely to have access to surgical support beyond neurosurgery.
Given the extent of variation between hospitals in the facilities available for head injured children, further comparative studies into the standards of care delivered and outcomes (including a confidential enquiry) are indicated.
评估英格兰、威尔士和北爱尔兰的儿童医院就诊分布情况，以及头部受伤儿童的护理组织方式。
对 2009 年 9 月至 2010 年 4 月期间有资格参与调查的英格兰、威尔士、北爱尔兰和英联邦属地（海峡群岛和马恩岛）的 245 家医院进行了横断面调查。调查涵盖了医院详细信息、科室和流程、急诊科活动、影像学、入院和出院程序、转诊和转院、文件记录、培训和审核、信息和咨询，以及非故意头部受伤。
64%的医院有明确的头部受伤儿童管理路径。经常有医院声称自己是专门的创伤或神经外科中心，但实际上并不提供儿童重症监护服务。82%的儿童急诊科就诊是去那些无法在现场照顾重病儿童的医院。提供此类服务的医院更有可能在急诊科配备受过儿童培训的工作人员。他们也更有可能获得神经外科以外的手术支持。
鉴于医院在头部受伤儿童可用设施方面存在很大差异，需要进一步进行比较研究，以评估护理标准和结果（包括机密调查）。
