Analysis of Performance and Process Indices in the Pediatric Population with Major Trauma: The Real-Life of a Level 2 trauma Center

Background: Major trauma requires timely recognition and rapid, optimal care to reduce mortality

Objective: Describe analysis of performance and process indices 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 emergency room from 1 January 2014 to 31 December 2018 for major trauma. We then analyzed all the performance and process indices of the management of major trauma in ER.

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. 55% contracted the trauma on the road, 31% at home and 5% at school. Only 8% arrived self-presented, the remainder accompanied by the territorial emergency. Of these, 1% came with helicopter rescue. 88% accessed the medical examination with a high priority code and required medium high intensity of care, however, 12% were not recognized in triage because they were clinically (normal vital parameter). The findings, however, did classify the patients as major trauma. The trauma team as well as the emergency doctor was also composed of: in 51% of cases by resuscitator, 50% by neurosurgeon, 37% by pediatric surgeon, 36% by orthopedist and in 5% by otolaryngologist. 36% of patients performed E-FAST. 9% required chest and pelvis x-ray in shock room. All patients performed Cts of which 34% chest CT, 34% abdomen CT, 66% brain CT, 32% limb CT. Only 5% were discharged. 95% were hospitalized either because they needed an observation period or because they needed surgery or intensive care.

Conclusion: The correct management of the major pediatric need for high resources and a multidisciplinary and multiprfessional management of individual cases.