Need for High-Intensity Care and Hospitalization Rate in the Pediatric Population with Major Trauma: Real-Life of a Level 2 Trauma Center

Background: Major trauma often requires high intensity of care and high need for hospital care to reduce mortality and residual comorbidities.

Objective: Describe need for high-intensity care and hospitalization rate in the pediatric population that comes to the ER for major trauma in real life in a trauma center 2° level.

Methods: We enrolled patients aged ≤ 14 years who were consecutively referred to our ER from 1 January 2014 to 31 December 2018 for major trauma. We then analyzed the methods of arrival, the severity code at the exit, the dynamics and causes of the accident , the outcomes, the need for medium - high intensity of care, the hospitalization rate, the need for surgery and hospitalization in intensive care units..

Results: We enrolled 99 patients. The average age was 7 years (59%M). 62% for major trauma, 35% for severe head injury, 3% for burns. 45% contracted the trauma on the road, 10% on the motocross track, 31% at home and 5% at school. Only 8% arrived self-presented, the remainder accompanied by the territorial emergency services (118 in Italy, equivalent to American 911). Of these, 1% came with helicopter rescue. Only 5% were discharged. 95% were hospitalized either because they needed an observation period (29% in pediatrics), or because they needed deferred surgery or high monitoring (12% in orthopedics, 26% in pediatric surgery). 15% needed hospitalization in intensive care and 1% needed immediate access to the operating room. The totality of patients had elevated (yellow or red) severity code at discharge. The overall hospital stay in the emergency room was on average 305 minutes with a median of 97 minutes.

Conclusion: The pediatric population that reports major trauma requires medium-high intensity of care, a high rate of hospitalization even in departments with high intensity of care and surgery