A critical review of urban pediatric trauma.

Accidents are the leading single cause of childhood mortality in the United States. While prevention plays a major role in reducing morbidity and mortality, improvement in all aspects of management is a crucial goal. This study was designed to critically evaluate the prevalence and significant features of childhood injuries as experienced at Cook County Children's Hospital, including the transport system utilized. During a 2-year period (1 April 1979 to 31 March 1981) 719 pediatric patients with trauma were admitted to our institution. Forty-six per cent had lacerations, fractures, or wringer injuries serious enough to warrant hospitalization; 35% had isolated head injuries; and 10% had multiple injuries. Gunshot wounds, straddle injuries, and stab wounds formed the bulk of the rest. Forty-one patients were directly admitted to the intensive care unit with serious injuries, half of whom were transferred after initial care (or no care) from an outlying hospital with an average transport time of 4 hours. Four of the transferred patients died within 24 hours and three had serious sequelae. A review of their injuries showed that early, aggressive, and coordinated management would have significantly reduced the morbidity and mortality. There were no deaths and only one serious sequela in the patients brought directly to our institution. A detailed presentation of the direct correlation between improved survival and early initiation of specialized care to these traumatized children is discussed.