Children in the United States account for nearly 12 million injury-related emergency department (ED) visits each year (Centers for Disease Control and Prevention, 2016). In each of these encounters, the pediatric patient will interact with a nurse. For many, the images of freestanding children's hospitals come to mind when they hear the words pediatric trauma. Almost half of all children in the United States live more than 30 min from a Pediatric Trauma Center, meaning that many injured children are first cared for at a nonpediatric trauma center (United States Government Accountability Office, 2017). Conversations about improving care for pediatric trauma patients need to be among all types of health care settings. Nurses caring for injured children, regardless of the setting, need access to continuing education in pediatric trauma.
In this pediatric-specific issue of the Journal of Trauma Nursing (JTN), you will find that although there are continuing education programs focused on pediatric trauma nursing sponsored by professional organizations and entities, there remains significant variability in the access and utilization of these courses. In addition, this issue presents data to support that there is variability on what nurses perceive their learning needs to be and their access to evidence-based guidelines for the care of injured children. From attending the Fourth World Trauma Congress this past fall in San Diego, CA, it was evident that nurses from around the world are passionate about similar themes and are ready to collaborate to improve outcomes for injured children.
Pediatric trauma care providers should be cognizant that pediatric patients are a special population when it comes to receiving trauma care. The saying “they're not just little adults” is important to keep in mind when we think about pediatric triage and resuscitation in the trauma bay. Children also have anatomical differences when compared with adults. Their large heads can increase incidence for falls (Pandya, Upasani, & Kulkarni, 2013). This issue explores many topics that reflect the clinical nuances in the care of injured children including articles about a decreasing pediatric trauma length of stay, an exploration of the continuing education programs that our own members of the Society of Trauma Nurses (STN) engage in to learn more about the care of injured children, and a pediatric fall prevention program.
A trauma nurse who encounters pediatric trauma patients should be aware of subtle signs of emotional stress, inappropriate developmental behavior, and mechanism of injuries that are suspicious for the injury pattern (Escobar et al., 2017). Not only does trauma impact the person physiologically but emotionally as well (Makley & Falcone, 2010). This issue highlights implementation of a multidisciplinary program dedicated to pediatric trauma survivors at a children's hospital as well as experiences cohorting trauma patients in a medical/surgical unit at a Level I Pediatric Trauma Center in an effort to improve collaboration and documentation.
The Pediatric Steering Committee for STN has worked hard in developing the themes for this pediatric-specific issue of JTN to highlight some of the significant challenges and opportunities that we face as nurses who care for injured children regardless of the type of facility we work at. We would like to thank the authors for their commitment to improving the care of injured children.
Centers for Disease Control and Prevention. (2016). Reasons for emergency room use among U.S. children: National Health Interview Survey, 2012. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db160.htm
Escobar M. A., Flynn-O'Brien K. T., Auerbach M., Tiyyagura G., Borgman M. A., Duffy S. J., Maguire S. A. (2017). The association of nonaccidental trauma with historical factors, examination findings, and diagnostic testing during the initial trauma evaluation. Journal of Trauma and Acute Care Surgery, 82(6), 1147–1157.
Makley A. T., Falcone R. A. (2010). Posttraumatic stress disorder in the pediatric trauma patient. Seminars in Pediatric Surgery, 19, 292–299.
Pandya N. K., Upasani V. V., Kulkarni V. A. (2013). The pediatric polytrauma patient: Current concepts. Journal of the American Academy of Orthopaedic Surgeons, 21, 170–179.
United States Government Accountability Office. (2017). Pediatric trauma centers: Availability, Outcomes, and federal support related to pediatric trauma care. Washington, DC: Author. Retrieved from https://www.gao.gov/assets/690/683706.pdf