Paediatric and adolescent trauma care within an integrated trauma system

Background: The aim of this study was to establish the profile and outcomes of paediatric major trauma care (PTMC) within an integrated inclusive regionalised trauma system. Methods: Prospectively collected data from July 2001 to June 2009 from the Victorian State Trauma Registry of patients aged <18 years were reviewed. Results: There were 1634 major trauma cases with a median (IQR) age of 13 (6-16) years and 69% were male. The median ISS (IQR) was 18 (16-26). There were 1361 patients treated at a major trauma centre of which 69% (n = 943) were treated at the PMTC. Head injury (AIS > 2) was the most frequent injury (n = 950, 58%). Surgery was required in 39% (n = 637) of all cases; 437 patients in the 10-17 year old group and 200 patients in the 0-9 year old group; the mortality was 6.6%. There were 530 patients (32.4%) ventilated in ICU; these had a median ISS (IQR) of 25 (17-34) and mortality of 7.4%. Improvements in risk-adjusted mortality have occurred as the years have progressed [adjusted OR 95% CI: 0.87 (0.76, 0.99)] and being treated at a Level 1 trauma centre was associated with lower adjusted odds of mortality [adjusted OR 95% CI: 0.27 (0.11, 0.68)]. Conclusion: The establishment of this integrated inclusive regionalised trauma system has been associated with progressively improving risk-adjusted mortality. The relatively low volume of major trauma requiring surgery in the 0-9 year old age group is notable, creating a challenging environment for maintaining skills and institutional preparedness.