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Is Pediatric Trauma Still a Surgical Disease? Patterns of Emergent Operative Intervention in the Injured Child

Acierno, Stephanie P. MD; Jurkovich, Gregory J. MD; Nathens, Avery B. MD, MPH

The Journal of Trauma: Injury, Infection, and Critical Care: May 2004 - Volume 56 - Issue 5 - p 960-966
doi: 10.1097/01.TA.0000123495.90747.BB
ORIGINAL ARTICLES
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Background: Nonoperative management of many pediatric injuries has generated debate as to whether surgeons must be routinely involved in the early assessment and management of pediatric trauma. This study examines the frequency of operative intervention among injured children and evaluates potential predictors of emergent intervention.

Methods: Pediatric (age < 18 years) patients were identified from the National Trauma Data Bank. Primary outcome measures were surgical intervention by specialty, time to intervention, and mortality. Prehospital factors were evaluated as predictors of emergent surgical intervention.

Results: Thirty percent of trauma admissions underwent operative intervention, with 57% of these requiring emergent surgery. Patients needing emergent general or neurosurgical intervention were at increased risk of death. Requiring one type of emergent surgical intervention was predictive of needing a second type of emergent procedure. Predictors of emergent general surgical intervention were penetrating mechanism, increasing age, and the presence of shock or coma.

Conclusion: These data support the continued routine involvement of surgeons in the initial assessment and management of the injured child.

From the University of Washington, Department of Surgery, Division of General and Trauma Surgery, Harborview Medical Center and the Harborview Injury Prevention and Research Center (G.J., A.N.), and the University of Washington Robert Wood Johnson Clinical Scholars Program (S.A.), Seattle, Washington.

Submitted for publication September 23, 2003.

Accepted for publication January 23, 2004.

This research was supported by the Robert Wood Johnson Clinical Scholars Program and grant R49/CCR002570 from the Centers for Disease Control and Prevention.

Presented at the 62nd Annual Meeting of the American Association for the Surgery of Trauma, September 11–13, 2003, Minneapolis, Minnesota.

Address for reprints: Stephanie P. Acierno, MD, University of Washington Robert Wood Johnson Clinical Scholars Program, Box 357183, Seattle, WA 98195-7183; email: sacierno@u.washington.edu.

© 2004 Lippincott Williams & Wilkins, Inc.