Differences in the outcome of seriously injured children depending on treatment level

Abstract

Many publications, mainly from other countries, suggest that the treatment of seriously injured children might be better in specialised paediatric trauma centres than in general trauma centres. Data from Germany are not available yet, but those from abroad were used for the recommendations made by the German Association for Trauma Surgery (DGU) on the topic of paediatric trauma in the "White Paper on Trauma Care". The goal of this study was to analyse whether the outcome of severely injured children is dependent on treatment level and on the availability of a paediatric surgeon based on the given data. Data from the "TraumaRegister DGU" between 2002 and 2012 were used. Children aged 1-15years treated during the period 2002-2012 were included. Severity had to reach a minimum Injury Severity Score (ISS) of 9 and the treatment had to involve astay at an Intensive Care Unit. Patients with an ISS ≥9 who died were also included to take into consideration children with particularly severe injuries. Hospitals without a paediatric surgeon transferred the patients significantly more frequently (p< 0.001). Mean hospital stay was shorter in centres with a paediatric surgeon, with slightly longer median stays at an Intensive Care Unit. Hospitals without a paediatric surgeon performed slightly more frequent surgical interventions on injured children (barely significant at p= 0.045). The death rate and the calculated Revised Injury Severity Classification (RISC)II prognosis were the same with or without the presence of apaediatric surgeon. No difference was found in the Glasgow Outcome Score (GOS) between the group with and the group without involvement of a paediatric surgeon. Overall, the medical care of seriously injured and polytraumatised children in Germany is good at all levels of treatment whether apaediatric surgeon is involved or not.