Jordan Robert, Westacott Daniel, Patel Hiten, Pattison Giles
Departments of aTrauma and Orthopaedics bRadiology, University Hospitals Coventry & Warwickshire, Coventry, UK.
Eur J Emerg Med. 2015 Jun;22(3):206-10. doi: 10.1097/MEJ.0000000000000135.
Our study analyzes the impact of becoming a major trauma centre (MTC) on paediatric trauma workload in a centre outside a major city without specialist paediatric surgical services.
Paediatric 'trauma calls' presenting between 1 April 2010 and 31 March 2013 were retrospectively reviewed. As our centre became an MTC on 1 April 2012, our study population was split into 'pre-MTC' and 'post-MTC' groups. Patient demographics, mechanism of injury, patient outcome, Injury Severity Score and results of radiological investigations were recorded.
There were 132 paediatric trauma calls, with a 72% annual increase post-MTC. More children with minor injuries, according to the Injury Severity Score, were seen post-MTC (47.5 vs. 29.6%). Although the proportion of patients undergoing a CT scanning remained static, the actual number increased and a higher proportion were normal in the post-MTC group (72.9 vs. 52.4%). This contributed to a higher proportion of patients being discharged home directly from the emergency department post-MTC (47.5 vs. 36.6%). Practice moved away from targeted CT scanning, in favour of trauma scanning post-MTC.
The implementation of a regional trauma network has led to a rise in paediatric trauma cases. Paediatric trauma patients tend to be less severely injured, but the proportion undergoing CT scanning has remained the same, and these scans are more likely to be normal. A more rational approach for imaging of paediatric trauma patients is required to reduce the potentially harmful effects of exposure to ionizing radiation, and criteria for implementing trauma calls in children should be reconsidered.
我们的研究分析了成为主要创伤中心（MTC）对一个没有专业小儿外科服务的大城市以外中心的小儿创伤工作量的影响。
回顾性分析2010年4月1日至2013年3月31日期间出现的小儿“创伤呼叫”。由于我们的中心于2012年4月1日成为MTC，我们的研究人群被分为“MTC前”和“MTC后”两组。记录患者人口统计学、损伤机制、患者结局、损伤严重程度评分和放射学检查结果。
共出现132次小儿创伤呼叫，MTC后每年增加72%。根据损伤严重程度评分，MTC后见到更多轻伤儿童（47.5%对29.6%）。虽然接受CT扫描的患者比例保持不变，但实际人数增加，MTC后组中正常比例更高（72.9%对52.4%）。这导致MTC后直接从急诊科出院的患者比例更高（47.5%对36.6%）。做法从有针对性的CT扫描转向MTC后的创伤扫描。
区域创伤网络的实施导致小儿创伤病例增加。小儿创伤患者往往受伤较轻，但接受CT扫描的比例保持不变，而且这些扫描更可能正常。需要一种更合理的小儿创伤患者成像方法，以减少暴露于电离辐射的潜在有害影响，并且应重新考虑儿童创伤呼叫的实施标准。
