The first two years' experience with major trauma at a pediatric trauma center.

We reviewed the records of 233 patients with major trauma admitted to The Children's Hospital of Alabama during the first 2 years of operation of its Pediatric Trauma Center. The male-to-female ratio was 1.7:1. The highest incidence of trauma occurred in the spring (88 patients, 38%) and the lowest in the winter (36 patients, 15%). Most children (184, 79%) were injured between noon and midnight. Blunt mechanisms of injury accounted for 206 patients (88%), penetrating for 17 (7%), and burns for ten (4%). The distribution of injuries by organ system was head/neurologic, 185 patients (79%); musculoskeletal, 83 (36%); thoracic, 57 (24%); abdominal, 29 (12%); major soft-tissue, 26 (11%), genitourinary, 11 (5%); and vascular, 11 (5%). Surgery was required at some point during the hospitalization in 89 patients (38%). Seventy-two patients (31%) experienced 115 complications. The mean length of time spent for resuscitation and stabilization in the trauma room was 49 min. The mean ICU stay was 3.2 days. Total length of hospitalization averaged 11.2 days. Twenty-six patients (11%) died. The Pediatric Trauma Score and the Pediatric Coma Score were found to be predictive of outcome. The organization and function of the trauma team is described, and public health concerns are discussed.