A learning curve? The development of a multidisciplinary trauma service improves outcomes for injured children.

Louise Adamson, Katie Rollins, Patrick Davies, Adam Brooks

• Trauma mdt

Prehospital services

Emergency Department

Radiology

Theatres

Critical care

(Major Trauma ward)

Rehabilitation

Outcome

Objectives

• To identify the types of injuries seen in a new regional combined Adult/Paediatric Major Trauma Centre (MTC).

• To discuss how service development and MTC evolution have affected outcomes for injured children.

Year 1: 1st April 2012 – 31st March 2013•Period 1 – April – September•Period 2 – October – March

Year 2: 1st April 2013 – 31st March 2014•Period 3 – April – September•Period 4 – October - March

• Mechanism & pattern• Demographics• Resource demands• Outcomes

Mechanism & pattern Demographics

Overall & adjusted mortality Resource demand

Outcome Measures

163 injured children

15 ISS<9

74 ISS 9-15

74 ISS 16+

148moderately-

severely injured children

62 Yr 1

Apr-Sep 32

Oct-Mar 30

86 Yr 2

Apr-Sep 56

Oct-Mar 30

DemographicsYear 1 Year 2 p

Number 62 86 ------

Male (%) 79 70 n.s.

Age (in years, mean) 6.9 7.0 n.s.

Penetrating injuries (%) 2 0 n.s.

Transfers in (%) 24 23 n.s.

ISS (median) 16 13 n.s.

ISS >15 (%) 53 48 n.s.

Mechanism of injury

3

1

34

1

18

5

Year 1

BlowCrushFallStabbingRTCOther

71

42

0

32

4

Year 2

Year 1 Year 2

Resource demand

• Resource demand – number of operations, hospital admission, LOS, ICU admission

Year 1 Year 2 p

Operations (n) 19 43 ---------

Operations (mean per patient) 0.31 0.5 n.s.

Length of hospital stay (median) 6 7 n.s

Admissions to PICU (n) 16 30 -----------

Admissions to PICU (%) 25.8 34.9 n.s.

PICU LOS (median) 2 3 n.s.

RecoveryYear 1 Year 2 p

Good recovery (n) 56 82n.sModerate-Severe

Disability (n) 2 3

Death (n) 4 1Crude mortality (%) 6.5 1.2 n.s.

Unexpected survivors (n) 0 3 n.s.

Unexpected deaths (n) 2 1 n.s.

Adjusted mortality (W statistic) -3.23 2.33 --------

Blunt mechanism

Head and limb injuries

predominate

Workload increasing

Outcome improving

Summary

Conclusion

Increasing experience in a new major trauma system is resulting in improved survival for paediatric patients.

Thank you