Paediatric and adolescent trauma care within an integrated trauma system

Injury. 2012 Dec;43(12):2006-11. doi: 10.1016/j.injury.2011.08.032. Epub 2011 Oct 5.


Background: The aim of this study was to establish the profile and outcomes of paediatric major trauma care (PTMC) within an integrated inclusive regionalised trauma system.

Methods: Prospectively collected data from July 2001 to June 2009 from the Victorian State Trauma Registry of patients aged <18 years were reviewed.

Results: There were 1634 major trauma cases with a median (IQR) age of 13 (6-16) years and 69% were male. The median ISS (IQR) was 18 (16-26). There were 1361 patients treated at a major trauma centre of which 69% (n=943) were treated at the PMTC. Head injury (AIS>2) was the most frequent injury (n=950, 58%). Surgery was required in 39% (n=637) of all cases; 437 patients in the 10-17 year old group and 200 patients in the 0-9 year old group; the mortality was 6.6%. There were 530 patients (32.4%) ventilated in ICU; these had a median ISS (IQR) of 25 (17-34) and mortality of 7.4%. Improvements in risk-adjusted mortality have occurred as the years have progressed [adjusted OR 95% CI: 0.87 (0.76, 0.99)] and being treated at a Level 1 trauma centre was associated with lower adjusted odds of mortality [adjusted OR 95% CI: 0.27 (0.11, 0.68)].

Conclusion: The establishment of this integrated inclusive regionalised trauma system has been associated with progressively improving risk-adjusted mortality. The relatively low volume of major trauma requiring surgery in the 0-9 year old age group is notable, creating a challenging environment for maintaining skills and institutional preparedness.

MeSH terms

  • Adolescent
  • Adolescent Health Services
  • Child
  • Child Health Services
  • Child, Preschool
  • Emergency Medical Services / statistics & numerical data*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Injury Severity Score
  • Male
  • Practice Guidelines as Topic
  • Prospective Studies
  • Registries
  • Trauma Centers / statistics & numerical data*
  • Triage*
  • Victoria / epidemiology
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / rehabilitation
  • Wounds and Injuries / therapy*