PEDIATRIC TRAUMA PATIENTS IN AN ADULT TRAUMA CENTER

The injury patterns, age distribution, and outcome of pediatric patients (age <15 years) treated in an ''adult'' trauma center is incompletely defined. A total of 1115 pediatric trauma patients (9.6% total trauma admissions) treated over a 6-year period in a level I suburban trauma center without a pediatric trauma service or a pediatric surgeon were reviewed for age distribution; injury mechanism, injury pattern, and injury severity; surgical procedures; disposition; and mortality. All charts were subject to internal and external peer review, including five site surveys. Resuscitation, surgery, critical care, and stepdown management were provided by a trauma team led by in-house attending trauma surgeons (mean PGY = 20). Of the patients 22% were preschool (age 0-4 years), and 34% were adolescent (age 12-14 years); the mechanism was blunt (96%), with motor vehicular crash being the most frequent; the mean ISS was 11.1, with 39% of ISSs > 9; significant injuries (AIS score greater-than-or-equal-to 3) of the head and extremities were dominant; 3.9% of patients underwent laparotomy, primarily for injuries to the bowel, spleen, and liver. There was only one taparotomy in the 0-4 year age group. The mean length of stay of patients was 6.2 days, with 38% requiring time in the ICU. Of the patients, 90% were discharged home; the treated trauma patient mortality rate was 25 of 988, or 2.5%; 92% of these died of nonsurvivable head injuries. No deaths were judged preventable. There was no significant difference of noncompliance for the pediatric patients when compared with the adult population in five trauma audit filters. The z score analyses (n = 392) were within normal limits. For pediatric trauma admissions to an ''adult'' suburban level I trauma center, one third were adolescent; only one fourth were preschool; abdominal surgery was uncommon (rare in preschool); mortality was from nonsurvivable head injury; and outcome as measured by mortality, peer review, and patient disposition appeared favorable. The presence of a pediatric trauma surgeon and a separate pediatric trauma service may not be essential or practical.