I don’t have to tell you that trauma is a big deal. It is the leading killer of children between 1 and 18 years of age. The AAP just unleashed a new practice statement and I thought that it would be a good idea to share it and my thoughts with you.
Access to Trauma Services
Per the AAP, “an estimated 17.4 million children do not have access to a pediatric trauma center within 60 minutes.” Any facility that cares for children therefore need to be ready. This includes having personnel and resources (child sized equipment for instance) at the ready. Prompt transfer to a level I pediatric trauma center is ideal for the most seriously injured children. This optimally includes pediatric ICUs and specialized interfacility transport mechanisms.
The presence of a local pediatric trauma center (PTC)is associated with lower mortality rates. Per Notrica et al “mortality was 37% lower among states with only Level I PTCs” and “higher ratios of Level I vPTCs per population correlated with lower mortality rates” overall.
Prehospital Care
Despite further evolution and improvement in prehospital settings there are gaps in the literature in the following areas that will need to be addressed in the near future. These include;
- Best practices for pediatric resuscitation in out-of-hospital traumatic cardiac arrest
- Fluid administration
- Cervical spine stabilization
- Airway management of children
More Take Home Points
- Research is needed to develop child-specific protocols. An example is this retrospective study by Sun et al, where an age specific C-spine injury protocol reduced CT use by 60%.
- Don’t forget that many seriously injured small children are potentially victims of abuse. You need to know how to get access to appropriate social services and other resources.
- Early transfer is important. Don’t delay care at a referring facility. An example – You are caring for a child involved in a motor vehicle collision with a seat belt sign and abdominal pain. The BP is normal and the child’s mental status is reassuring. Transfer this child to a Level I center early, don’t obtain the CT scan and delay moving to definitive care. Just because you can get the CT doesn’t mean you have everything you need to deal with the results.
- Know where your local trauma centers are – and how to get a patient there!
