[Quality of initial trauma care in paediatrics]

Quality assessment in initial paediatric trauma care: Systematic review from prehospital care to the paediatric intensive care unit

BACKGROUND

Trauma is the most common cause of death and disability in the paediatric population. There are a huge number of variables involved in the care they receive from health care professionals.

AIM

The aim of this study was to review the available evidence of initial paediatric trauma care throughout the health care process with a view to create quality indicators (QIs).

STUDY DESIGN

A systematic review was performed from Cochrane Library, Medline, Scopus and SciELO between 2010 and 2020. Studies and guidelines that examined quality or suggested QI were included. Indicators were classified by health care setting, Donabedian's model, risk of bias and the quality of the publication with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment.

RESULTS

The initial search included 686 articles, which were reduced to 22, with 15 primary and 7 secondary research articles. The snowball sampling technique was used to add a further seven guidelines and two articles. From these, 534 possible indicators were extracted, summarizing them into 39 and grouping the prehospital care indicators as structure (N = 5), process (N = 12) and outcome (N = 3) indicators and the hospital care indicators as structure (N = 4), process (N = 10) and outcome (N = 6) indicators. Most of the QIs have been extracted from US studies. They are multidisciplinary and in some cases are based on an adaptation of the QIs of adult trauma care.

CONCLUSIONS

There was a clear gap and large variability between the indicators, as well as low-quality evidence. Future studies will validate indicators using the Delphi method.

RELEVANCE TO CLINICAL PRACTICE

Design a QI framework that may be used by the health system throughout the process. Indicators framework will get nurses, to assess the quality of health care, detect deficient areas and implement improvement measures.

Epidemiology of paediatric trauma in Norway: a single-trauma centre observational study

Background

Trauma is a major cause of mortality and morbidity in children globally. The burden of injury shows substantial geographical differences, with a significant mortality reduction in children in Norway during the last four decades. The aim was to describe the current epidemiology, resource use and outcome for all potential severely injured paediatric patients admitted to a Norwegian trauma centre.

Methods

This was a single-centre retrospective observational study. All patients aged 0–17 years received by a trauma team between 01 January 2004 and 31 December 2016 (13 years) at St. Olav’s University Hospital were included. Severe injury was defined as Injury Severity Score > 15.

Results

A total of 873 patients were included, of which 536 (61%) were male. The median age was 13 years (IQR 7–16). Six per cent (n = 52) of the patients were transferred from other hospitals. Blunt trauma constituted 98%, with traffic (n = 532/61%) and falls (n = 233/27%) as the most common mechanisms. Eight patients (1%) died within 30 days of hospital admission. Fifteen per cent (n = 128) were severely injured. Among the patients transferred from another hospital, 46% (n = 24) had severe injuries. Helicopter Emergency Medical Services (HEMS) were more used in younger age groups and in patients more severely injured.

Conclusions

In a developed healthcare system, the number of potentially severely injured children is small and with very few deaths following trauma. Transport and falls represent the most common causes of injury throughout all age groups, though with a tendency towards more transport-related injuries with increasing age. In-hospital trauma care is characterized by a low threshold for a multidisciplinary reception, low use of intensive care and need for emergency surgical procedures, though with increased need in the older children.

Electronic supplementary material

The online version of this article (10.1186/s12245-019-0236-9) contains supplementary material, which is available to authorized users.