Patel Vrutant, Khatun Rahima, Carmack Mary, Calhoun Jeanet, Shim Joon K
Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA.
Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Surg Pract Sci. 2023 Jun 9;14:100186. doi: 10.1016/j.sipas.2023.100186. eCollection 2023 Sep.
Rural hospitals cover 20% of the United States (US) population with only 10% of physician coverage. A mismatch exists in pediatric trauma resources as there is overwhelming trauma support concentrated in urban trauma centers. Well-established guidelines for evaluating pediatric trauma patients in resource-limited environments are currently not available. Herein we identify the imaging practices at a level III rural trauma center to establish a protocol for handling pediatric traumas.
The National Trauma Data Bank was used to identify 155 pediatric trauma patients (age <17 years) between 2017 and 2021. A single-center retrospective chart review was performed to identify patient demographics, mechanism of injury, imaging performed and pertinent imaging findings, and management of the patient i.e., whether they were discharged, admitted, or transferred.
Blunt mechanisms were responsible for most traumas (90%). There were 64 patients (41.3%) who received imaging. Falls (49.3%) were the most common injury. Most of the patients were discharged home (73.4%) and 23.9% were transferred to a tertiary center. The mean time for transfer to a tertiary center was ∼176 min. The most frequently performed type of surgical intervention was orthopedic (59.3%).
An established pediatric trauma imaging protocol is warranted to adopt a higher level of pediatric trauma care for treatment and/or stabilization purposes. Using a tertiary care model and established pediatric trauma guidelines, we propose a model for use in resource-limited rural settings and aim to reduce unnecessary imaging of pediatric trauma patients and overall radiation exposure.
美国农村医院覆盖了20%的人口，但医生覆盖率仅为10%。儿科创伤资源存在不匹配的情况，因为大量的创伤支持集中在城市创伤中心。目前尚无在资源有限环境中评估儿科创伤患者的成熟指南。在此，我们确定了一家三级农村创伤中心的成像实践，以制定处理儿科创伤的方案。
利用国家创伤数据库识别出2017年至2021年间的155名儿科创伤患者（年龄<17岁）。进行了一项单中心回顾性病历审查，以确定患者的人口统计学特征、损伤机制、所进行的成像检查及相关成像结果，以及患者的治疗情况，即他们是出院、住院还是转院。
钝性机制导致了大多数创伤（90%）。有64名患者（41.3%）接受了成像检查。跌倒（49.3%）是最常见的损伤。大多数患者出院回家（73.4%），23.9%的患者被转至三级中心。转至三级中心的平均时间约为176分钟。最常进行的手术干预类型是骨科手术（59.3%）。
有必要制定既定的儿科创伤成像方案，以便为治疗和/或稳定病情采用更高水平的儿科创伤护理。利用三级护理模式和既定的儿科创伤指南，我们提出了一种适用于资源有限的农村地区的模式，旨在减少儿科创伤患者不必要的成像检查和总体辐射暴露。
