DO H Q, Hesselfeldt R, Steinmetz J, Rasmussen L S
Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Trauma Centre, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2014 Jan;58(1):98-105. doi: 10.1111/aas.12222. Epub 2013 Oct 30.
Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC).
This is an observational follow-up study that involves one level I TC and seven local hospitals. We included paediatric (< 16 years) and adult (≥ 16-≤ 79 years) trauma patients with a driving distance to the TC > 30 minutes. The primary end-point was the proportion of trauma patients arriving in the TC.
We included 1934 trauma patients, 238 children and 1696 adults. A total of 33/238 children (13.9%) vs. 304/1696 adults (17.9%) were transported to the TC post-injury (P = 0.14). Among these, children were significantly less injured than adults [median Injury Severity Score (ISS) 9 vs. 14, P < 0.01]. There was no significant difference between the groups in the proportion of seriously injured trauma victims (ISS > 15) taken to the TC [8/11 (72.7%) vs. 139/182 (76.4%)]. The corresponding figures for ISS < 15 were 25/227 (11.0%) and 164/1509 (10.9%), respectively. No significant difference was found in intensive care unit length of stay or time to TC arrival. No paediatric vs. 36/1671 (2.2%) adult deaths were observed at 30-day follow-up (P = 0.03).
There was no difference in the proportion of paediatric and adult trauma patients transported to the TC, neither overall nor among severely injured patients. Paediatric trauma patients admitted to the TC were, however, significantly less injured than adults.
严重儿童创伤较为罕见，院前及当地医院医护人员处理受伤儿童的经验往往有限。我们推测，更高比例的儿童创伤受害者被送往区域创伤中心（TC）。
这是一项观察性随访研究，涉及一家一级创伤中心和七家当地医院。我们纳入了距离创伤中心车程超过30分钟的儿科（<16岁）和成人（≥16 - ≤79岁）创伤患者。主要终点是抵达创伤中心的创伤患者比例。
我们纳入了1934例创伤患者，其中238例儿童和1696例成人。共有33/238例儿童（13.9%）与304/1696例成人（17.9%）在受伤后被转运至创伤中心（P = 0.14）。其中，儿童的受伤程度明显低于成人[损伤严重度评分（ISS）中位数为9 vs. 14，P < 0.01]。两组中被送往创伤中心的重伤创伤受害者（ISS > 15）比例无显著差异[8/11（72.7%）vs. 139/182（76.4%）]。ISS < 15的相应比例分别为25/227（11.0%）和164/1509（10.9%）。在重症监护病房住院时间或抵达创伤中心的时间方面未发现显著差异。在30天随访时，未观察到儿童死亡，而成人死亡36/1671例（2.2%）（P = 0.03）。
在被转运至创伤中心的儿童和成人创伤患者比例方面，总体及重伤患者中均无差异。然而，入住创伤中心的儿童创伤患者受伤程度明显低于成人。
