Abstract
Background: The availability of primary trauma care is well known to have a considerable impact on the prognosis of severe trauma patients. It is more difficult to assess and treat pediatric patients than adult patients, because of the differences in the physical size and vital signs between adult and pediatric patients. A medical care system for children was established in 2005 to improve the treatment levels for children with severe trauma at emergency medical care centers.
Objectives: This study was conducted to evaluate the effectiveness of the improved medical care system for pediatric patients with severe trauma at an emergency medical care center.
Methods: We enrolled all patients with severe trauma admitted to the hospital from 2000 to 2008. The therapeutic process and outcome of trauma care before and after the establishment of medical care system were retrospectively compared by reviewing the patients' medical records.
Results: A comparison of the therapeutic process in the pediatric population between the two time-periods (before and after the establishment of the improved medical care system; pre-group and post-group, respectively) revealed that the times spent in establishing an intravenous line (pediatric pre-group vs. post-group: 7 vs. 2 minutes), in accomplishing tracheal intubation (15 vs. 10 minutes), and until entering the CT room (31 vs. 23 minutes) were significantly decreased after the establishment of the improved medical care system. However, no significant differences in the time until the beginning of craniotomy / trepanation (pediatric pre-group vs. post-group: 58 vs. 59 minutes) or time spent in performing hemostatic procedures (60 vs. 48 minutes) were found between the two time-periods. A comparison of the therapeutic process between the pediatric and adult groups revealed that there were no significant differences in the time spent in establishing an intravenous line (pediatric post-group vs. adult group: 2 vs. 2 minutes), in accomplishing tracheal intubation (10 vs. 9 minutes), until entering the CT room (23 vs. 29 minutes), until the beginning of craniotomy/trepanation (pediatric post-group vs. adult group: 59 vs. 52 minutes), or in performing hemostatic procedures (48 vs. 50 minutes). The craniotomy/trepanation and hemostatic procedures could be started within 60 minutes. There were no cases of preventable death in the pediatric post-group.
Conclusion: Establishment of the improved medical care system for pediatric patients allowed provision of trauma care for children at a level equivalent to that for adult patients.
