Prehospital care and transportation of pediatric trauma patients

• Published in: The Journal of surgical research Vol. 197; no. 2; pp. 240 - 246
• Main Authors: Allen, Casey J., MD, Teisch, Laura F., BS, Meizoso, Jonathan P., MD, Ray, Juliet J., MD, Schulman, Carl I., MD, PhD, Namias, Nicholas, MD, Sola, Juan E., MD, Proctor, Kenneth G., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2015
• Subjects: Adolescent; Adolescents; Ambulance; Child; Child, Preschool; Children; Emergency medical services; Emergency Medical Services - methods; Emergency Medical Services - statistics & numerical data; Female; Humans; Infant; Injury Severity Score; Intubation, Intratracheal; Logistic Models; Male; Propensity Score; Resuscitation; Retrospective Studies; Surgery; Time Factors; Transportation of Patients - methods; Transportation of Patients - statistics & numerical data; Trauma Centers; Treatment Outcome; Wounds and Injuries - mortality; Wounds and Injuries - therapy; Children; Adolescents; Ambulance; Emergency medical services
• DOI: 10.1016/j.jss.2015.03.005
• ISSN: 0022-4804

Abstract Background Despite advances in prehospital emergency medical services (EMS), most advocate “scoop-and-run” over “stay-and-play.” However, there are almost no studies in children. We hypothesize that the transportation of mortally injured children is delayed and that the performance of prehospital interventions (PHIs) themselves delay transportation and worsen outcomes in pediatric trauma patients. Materials and methods A total of 1884 admissions (≤17-y-old) transported via EMS to a level 1 trauma center from January 2000–December 2012 were reviewed. Propensity scores were assigned based on the need for a PHI (intubation and resuscitation). PHI and non-PHI cohorts were matched 1:1 to compare outcomes. Data are expressed as mean ± standard deviation or median (interquartile range). Results The population was 11 ± 6 y, 70% male, 50% black, 76% blunt injury, injury severity score 13 ± 12, length of stay 3 (7) d, and mortality 3.6%. Incident to EMS arrival was 38 (20) min, EMS on-scene time was 14 (12) min, and overall time of arrival to hospital was 27 (15) min. Patients that were mortally wounded, despite having significantly higher rates of PHI, still had similar transportation times to those who survived. Mostly every measure of injury severity was worse in those who required PHI. When these factors were corrected, EMS on-scene time was 18 (13) versus 14 (13) min ( P  = 0.551), EMS arrival at the hospital was 31 (16) versus 28 (12) min ( P  = 0.292), length of stay was 5 (15) versus 4 (12) d ( P  = 0.368), and mortality was 31.7% versus 28.3% ( P  = 0.842) for PHI and non-PHI matched cohorts. Conclusions PHIs did not delay transportation times or worsen outcomes in pediatric trauma patients. Although mortally injured children more often required PHIs, this did not delay transportation to the trauma center.