Emergency department management of severely injured children in New South Wales.

Curtis, K; Kennedy, B; Lam, MK; Mitchell, RJ; Black, D; Burns, B; Dinh, M; Smith, H; Holland, AJ

Emergency department management of severely injured children in New South Wales.

Curtis, K Kennedy, B Lam, MK Mitchell, RJ Black, D Burns, B Dinh, M Smith, H Holland, AJ

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Emergency medicine Australasia : EMA, 2021
Issue Date:: 2021-06-08

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Field	Value	Language
dc.contributor.author	Curtis, K
dc.contributor.author	Kennedy, B
dc.contributor.author	Lam, MK
dc.contributor.author	Mitchell, RJ
dc.contributor.author	Black, D
dc.contributor.author	Burns, B
dc.contributor.author	Dinh, M
dc.contributor.author	Smith, H
dc.contributor.author	Holland, AJ
dc.date.accessioned	2021-09-30T03:30:48Z
dc.date.available	2021-05-05
dc.date.available	2021-09-30T03:30:48Z
dc.date.issued	2021-06-08
dc.identifier.citation	Emergency medicine Australasia : EMA, 2021
dc.identifier.issn	1742-6731
dc.identifier.issn	1742-6723
dc.identifier.uri	http://hdl.handle.net/10453/150748
dc.description.abstract	<h4>Objective</h4>Presentations to EDs for major paediatric injury are considerably lower than for adults. International studies report lower levels of critical intervention, including intubation, required in injured children. A New South Wales study demonstrated an adverse event rate of 7.6% in children with major injury. Little is known about the care and interventions received by children presenting to Australian EDs with major injury.<h4>Methods</h4>The ED care of injured children <16 years who ultimately received definitive care at a New South Wales Paediatric Trauma Centre between July 2015 and September 2016, and had an Injury Severity Score ≥9, required intensive care admission or died were included.<h4>Results</h4>There were 491 injured children who received treatment at 64 EDs, half (49.4%, n = 243) were treated initially in a Paediatric Trauma Centre. One third (32.8%) sustained an Injury Severity Score >12, more than half (n = 251, 51.1%) of children were classified as a triage category 1 or 2, and 38.3% received trauma team activation. Critical intervention was infrequent. Intubation was documented in 9.2% (n = 45), needle thoracostomy and activation of massive transfusion protocol in two (0.4%) and eight (1.6%) had intraosseous access established. Only a small proportion (14.7%, n = 63) had two or more observations outside the normal range.<h4>Conclusion</h4>A small proportion of children arriving in the ED post-major trauma have deranged clinical observations and receive critical interventions. The limited exposure in the management of trauma in paediatric patients requires measures to ensure clinicians have adequate training, skills and confidence to manage these clinical presentations in all EDs.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	Emergency medicine Australasia : EMA
dc.relation.isbasedon	10.1111/1742-6723.13805
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services
dc.subject.classification	Emergency & Critical Care Medicine
dc.title	Emergency department management of severely injured children in New South Wales.
dc.type	Journal Article
utslib.location.activity	Australia
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access	*
dc.date.updated	2021-09-30T03:30:47Z
pubs.publication-status	Published

Abstract:

Objective

Presentations to EDs for major paediatric injury are considerably lower than for adults. International studies report lower levels of critical intervention, including intubation, required in injured children. A New South Wales study demonstrated an adverse event rate of 7.6% in children with major injury. Little is known about the care and interventions received by children presenting to Australian EDs with major injury.

Methods

The ED care of injured children <16 years who ultimately received definitive care at a New South Wales Paediatric Trauma Centre between July 2015 and September 2016, and had an Injury Severity Score ≥9, required intensive care admission or died were included.

Results

There were 491 injured children who received treatment at 64 EDs, half (49.4%, n = 243) were treated initially in a Paediatric Trauma Centre. One third (32.8%) sustained an Injury Severity Score >12, more than half (n = 251, 51.1%) of children were classified as a triage category 1 or 2, and 38.3% received trauma team activation. Critical intervention was infrequent. Intubation was documented in 9.2% (n = 45), needle thoracostomy and activation of massive transfusion protocol in two (0.4%) and eight (1.6%) had intraosseous access established. Only a small proportion (14.7%, n = 63) had two or more observations outside the normal range.

Conclusion

A small proportion of children arriving in the ED post-major trauma have deranged clinical observations and receive critical interventions. The limited exposure in the management of trauma in paediatric patients requires measures to ensure clinicians have adequate training, skills and confidence to manage these clinical presentations in all EDs.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/150748