[Pediatric prehospital trauma care. A retrospective comparison of air and ground transportation]

U Schmidt, J Geerling, M Fühler, V Hubrich, M Richter, C Krettek
Der Unfallchirurg 2002, 105 (11): 1000-6

OBJECTIVE: In contrast to prehospital care of adult trauma victims, prehospital care providers have only limited clinical experience of pediatric trauma cases as these are relatively infrequent. Literature reports on prehospital pediatric trauma care given by paramedics are frequently found in the literature, but there are few publications analyzing the quality of prehospital trauma care provided by emergency physicians in the care of injured children. It was the goal of this study to analyze the prehospital care of the pediatric trauma victims transported to a trauma center by physician-staffed ambulances and helicopters.

METHODS: The study took the form of a retrospective 5-year review of pediatric trauma patients admitted to a trauma center. The inclusion criteria were age younger than 13 years and a NACA score higher than 3. In all, 104 patients were included, and these were divided into two groups, those transported to hospital by helicopter (RTH, n=87) and those taken to hospital by road ambulance (NEF, n=17).

RESULTS: With a mean NACA score of 4.6 and a mean ISS of 15, no significant differences were found between the two groups in either severity of injury or length of hospital stay. The mortality of the total patient population was 15.4%, with no evidence of preventable deaths in patients who were admitted to the trauma center with vital signs. Analysis of prehospital therapy showed no differences in the volume of intravenous fluids administered (RTH 636 ml vs NEF 476 ml) or in the proportion of children with a GCS<9 in whom endotracheal intubation was implemented (RTH 39/44 vs NEF 7/7). Placement of more than one i.v. line and endotracheal intubation were associated with longer times at the scene of the accident before patients were taken to hospital (>one i.v. corresponded to 9 min longer, and endotracheal intubation, to 10 min longer).

CONCLUSIONS: Prehospital pediatric trauma care delivered by physician-staffed ambulances or rescue helicopters is associated with a high rate of i.v. line placement (92%) and high intubation rates (90%) in patients with an altered level of consciousness (GCS<9). The prehospital care provided by helicopter or ground ambulance personnel was not different and was not associated with longer stays in the intensive care unit or longer overall stays in hospital. Scene times became longer with increasing number of i.v. line placements and with endotracheal intubation, but was not prolonged by a greater severity of injury as determined by the ISS. Preventable deaths were not observed in the patient population. In summary, owing to the the local infrastructure, pediatric trauma patients are more frequently transported to the trauma center by air (87 by air vs. 17 by road per 5-year time period). However, despite being less frequently involved in the case of pediatric trauma, the quality of care provided by road ambulance staff is similar to that in air ambulances.

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