C. J. Allen2, J. P. Meizoso2, J. Tashiro1, J. J. Ray2, C. I. Schulman2, H. L. Neville1, J. E. Sola1, K. G. Proctor2 1University Of Miami,Pediatric Surgery,Miami, FL, USA 2University Of Miami,Trauma And Critical Care,Miami, FL, USA
Introduction: Trauma is the leading cause of death and morbidity in children in the US. Aggressive efforts have been made to improve emergency medical transportation of injured children to major trauma centers. Still, controversy exists whether pre-hospital care improves outcomes or simply delays the necessary immediate transportation. We hypothesize that at large level 1 trauma center, with a mature pre-hospital network, pre-hospital care of severely injured children does not influence transportation time.
Methods: From January 2000 to December 2012, consecutive pediatric admissions (≤17y) at a Level I trauma center were retrospectively reviewed for demographics, mechanisms of injury (MOI), mode of transportation, transportation times, pre-hospital interventions, injury severity score (ISS), length of stay (LOS), and survival. We analyzed pre-hospital interventions and compared transport times in survivors and non-survivors, as this cohort represents the most severely injured. Parametric data presented as mean±standard deviation and nonparametric data presented as median(interquartile range).
Results: 1,878 admitted patients were transported via emergency medical services (EMS). Age was 11±6y with 70% male, 50% black; 76% sustained blunt injuries with an ISS of 13±12. Of these, 31% required operative intervention, LOS of 7±12, and mortality of 3.6%. Pre-hospital care, transport times, and ISS were compared between survivors and those who died in-hospital, see Table. There were no significant differences in EMS scene to hospital arrival times between those with and without on-scene shock (27(15)min vs 27(15)min, p=NS), or between those who required on-scene intubation (32(14)min vs 27(15)min, p=NS).
Conclusion: In the most severely injured children, those with ultimately fatal injuries, there are significantly increased rates of pre-hospital interventions, but on-scene and transportation times are not prolonged. There is no difference in pre-hospital transportation times between those with and without on-scene shock, or those requiring on-scene intubation. These results support the concept that pre-hospital interventions by skilled EMS are not associated with prolonged transportation times of critically injured pediatric trauma patients.
