Objective. Delay in the provision of definitive care for critically injured children may adversely effect outcome. We sought to speed care in the emergency department (ED) for trauma victims by organizing a formal trauma response system.Design. A case-control study of severely injured children, comparing those who received treatment before and after the creation of a formal trauma response team.Setting. A tertiary pediatric referral hospital that is a locally designated pediatric trauma center, and also receives trauma victims from a geographically large area of the Western United States.Subjects. Pediatric trauma victims identified as critically injured (designated as “trauma one”) and treated by a hospital trauma response team during the first year of its existence. Control patients were matched with subjects by probability of survival scores, and were chosen from pediatric trauma victims treated at the same hospital during the year preceding the creation of the trauma team.Interventions. A trauma response team was organized to respond to pediatric trauma victims seen in the ED. The decision to activate the trauma team (designation of patient as “trauma one”) is made by the pediatric emergency medicine (PEM) physician before patient arrival in the ED, based on data received from prehospital care providers. Activation results in the notification and immediate travel to the ED of a pediatric surgeon, neurosurgeon, emergency physician, intensivist, pharmacist, radiology technician, phlebotomist, and intensive care unit nurse, and mobilization of an operating room team. Most trauma one patients arrived by helicopter directly from accident scenes.Outcome Measures. Data recorded included identifying information, diagnosis, time to head computerized tomography, time required for ED treatment, admission Revised Trauma Score, discharge Injury Severity Score, surgical procedures performed, and mortality outcome. Trauma Injury Severity Score methodology was used to calculate the probability of survival and mortality compared with the reference patients of the Major Trauma Outcome Study, by calculation of z score.Results. Patients treated in the ED after trauma team initiation had statistically shorter times from arrival to computerized tomography scanning (27 ± 2 vs 21 ± 4 minutes), operating room (63 ± 16 vs 623 ± 27 minutes) and total time in the ED (85 ± 8 vs 821 ± 9 minutes). Calculation of z score showed that survival for the control group was not different from the reference population ( z = ?0.8068), although survival for trauma-one patients was significantly better than the reference population ( z = 2.102).Conclusion. Before creation of the trauma team, relevant specialists were individually called to the ED for patient evaluation. When a formal trauma response team was organized, time required for ED treatment of severe trauma was decreased, and survival was better than predicted compared with the reference Major Trauma Outcome Study population.
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机译：目的。延迟为重伤儿童提供最终护理可能会对结果产生不利影响。我们试图通过组织正式的创伤反应系统来加快急诊科（ED）对创伤受害者的护理。一项针对重伤儿童的病例对照研究，比较了在建立正式创伤反应小组之前和之后接受治疗的儿童。三级儿科转诊医院，这是一家在当地指定的儿科创伤中心，还接待了美国西部地理较大地区的创伤受害者。小儿创伤受害者被确定为重伤（称为“创伤一人”），并在其存在的第一年内由医院创伤应对小组进行了治疗。对照患者通过生存评分与受试者匹配，并从创建创伤团队之前一年在同一家医院接受治疗的小儿创伤受害者中选出。组织了一个创伤应对小组，以应对急诊科中发现的小儿创伤受害者。根据从院前护理提供者那里收到的数据，由小儿急诊医学（PEM）医师决定启动创伤小组（将患者指定为“创伤一人”）。激活会导致小儿科医生，神经外科医生，急诊医师，专科医生，药剂师，放射技师，抽血医生和重症监护室护士通知并立即前往急诊室，并动员手术室团队。大多数受伤的一例患者是直接从事故现场乘坐直升飞机抵达的。记录的数据包括识别信息，诊断，进行计算机断层扫描的时间，ED治疗所需的时间，入院修订的创伤评分，出院伤害严重度评分，所执行的手术程序以及死亡率。通过计算z得分，使用创伤损伤严重程度评分方法来计算与主要创伤结果研究的参考患者相比存活和死亡的概率。从创伤团队开始到急诊室就诊的患者从到达到计算机断层扫描的时间在统计学上较短（27±2 vs 21±4分钟），手术室（63±16对623±27分钟）和在急诊室的总时间（85） ±8 vs 821±9分钟）。 z得分的计算表明，对照组的存活率与参考人群没有差异（z = 0.8068），尽管创伤一患者的存活率明显好于参考人群（z = 2.102）。在建立创伤小组之前，相关专家被分别请教医生进行患者评估。当组织了一个正式的创伤应对小组时，与参考的重大创伤结果研究人群相比，ED治疗严重创伤所需的时间减少了，并且生存期比预期的要好。
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