Can adult trauma surgeons care for injured children?

Large urban trauma centers care for injured children as well as adults in many areas of the country, but the quality of care in these hospitals has not been evaluated versus that available at pediatric trauma centers. The recent validation of TRISS methodology in pediatric populations allowed us to evaluate the quality of pediatric trauma care being provided in a level I trauma center treating injured patients of all ages. We reviewed the records of 353 injured children (aged 0-17 years) who were admitted to our trauma center over a 30-month period for the following data: demographics, mechanism of injury, initial physiologic status (RTS), surgical procedures required, need for intensive care, nature and severity of the injuries (ISS), and outcome. TRISS analysis allowed us to compare our population with the Major Trauma Outcome Study. Only two of the 21 total deaths (overall mortality, 6%) were unexpected, and there were seven unexpected survivors. One hundred twenty-one patients underwent emergency surgical procedures and 63 required admission to the intensive care unit. The Z scores ranged from +0.32 for the children aged less than 2 years to +3.98 for the older age group (14—17 years). We conclude that the quality of care for pediatric trauma patients admitted to trauma centers that care for patients of all ages compares favorably with national standards. In most areas of the country, improvements in pediatric trauma care will likely come from addressing the special needs of injured children in general trauma centers rather than from developing separate pediatric facilities.