Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven LHD, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; George Institute for Global Health, King St, Newtown, NSW, Australia.
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia.
Injury. 2022 Jan;53(1):61-68. doi: 10.1016/j.injury.2021.02.036. Epub 2021 Feb 17.
Timely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment locally and then require transfer. Little is known about the factors that then impact timely arrival of injured children to definitive care.
This included children admitted between July 2015 and September 2016, <16 years with an injury severity (ISS) ≥9; or requiring intensive care admission; or deceased following injury. Children were identified through the three PTCs, NSW Trauma Registry and NSW Medical Retrieval Registry.
There were 593 children admitted following injury and 46% required transfer to a PTC. There was no significant difference in age, ISS, ICU admission or head injury (AIS >2) between transferred and directly transported cohorts. There were significant differences in mechanism of injury between the two groups (χ(9) = 45.9, p < 0.001). The median (IQR) time to book a transfer from arrival at the referring facility, was 146.5 (86-238) minutes. Time from injury to arrival at the PTC more than doubled for children transferred, with significant and unwarranted variability between transporting agencies resulting in unwarranted delays to surgical intervention. For example, time spent at the referring facility by Aeromedical Retrieval Service was less than half that of the Newborn & paediatric Emergency Transport Service [53 (IQR:47-61) vs 115 (84-155) minutes (p <0.001)].
Clinicians caring for paediatric trauma patients in facilities outside trauma centres require the capability and opportunity to identify and notify early those requiring transfer for ongoing management. The provision of a streamlined referral and transfer process for all paediatric trauma patients requiring treatment in NSW PTCs would reduce the burden on the referring facility, reduce variation amongst transport providers and improve time to definitive care.
及时的儿科创伤治疗会影响患者和家长的身体和情绪结果。新南威尔士州（NSW）地域广阔，所有三个新南威尔士州儿科创伤中心（PTC）都位于两个主要城市，这意味着一些受伤的儿童不可避免地会先在当地接受初步治疗，然后再转院。对于影响受伤儿童及时到达确定性治疗的因素，我们知之甚少。
这项研究纳入了 2015 年 7 月至 2016 年 9 月期间收治的年龄<16 岁、ISS≥9 分的创伤患儿；或需要入住重症监护病房的患儿；或受伤后死亡的患儿。患儿通过三个 PTC、新南威尔士州创伤登记处和新南威尔士州医疗检索登记处确定。
共有 593 名患儿因受伤而住院，其中 46%需要转至 PTC。转院组和直接转运组在年龄、ISS、入住 ICU 或头部损伤（AIS>2）方面无显著差异。两组患儿的损伤机制存在显著差异（χ(9) = 45.9，p < 0.001）。从到达转诊机构到预约转院的中位（IQR）时间为 146.5（86-238）分钟。与直接转运的患儿相比，转院患儿从受伤到到达 PTC 的时间增加了一倍以上，转运机构之间存在显著且不必要的差异，导致手术干预不必要的延迟。例如，空中医疗救援服务在转诊机构的停留时间不到新生儿和儿科紧急转运服务的一半[53（IQR：47-61）比 115（84-155）分钟（p<0.001）]。
在创伤中心以外的医疗机构照顾儿科创伤患者的临床医生需要有能力和机会识别并尽早通知那些需要转院进行持续管理的患者。为所有需要在新南威尔士州 PTC 接受治疗的儿科创伤患者提供简化的转诊和转院流程，将减轻转诊机构的负担，减少转运提供者之间的差异，并缩短确定性治疗的时间。
