Paediatric major trauma in the setting of the Irish trauma network

Timothy McAleese; Louise Brent; Patrick O'Toole; Keith Synnott; Nuala Quinn; Conor Deasy; Eoin Sheehan

doi:10.1016/j.injury.2021.05.032

Paediatric major trauma in the setting of the Irish trauma network

Injury. 2021 Aug;52(8):2233-2243. doi: 10.1016/j.injury.2021.05.032. Epub 2021 May 21.

Authors

Timothy McAleese¹, Louise Brent², Patrick O'Toole³, Keith Synnott⁴, Nuala Quinn⁵, Conor Deasy⁶, Eoin Sheehan⁷

Affiliations

¹ National University of Ireland, Galway, Ireland; Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Ireland. Electronic address: timmcaleese@rcsi.ie.
² Major Trauma Audit, National Office of Clinical Audit, Ireland.
³ Department of Trauma and Orthopaedics, CHI at Crumlin, Dublin, Ireland.
⁴ National Clinical Lead for Trauma services, Dublin, Ireland.
⁵ Department of Paediatric Emergency Medicine, CHI at Temple Street.
⁶ Major Trauma Audit Clinical Lead, National Office of Clinical Audit, Ireland.
⁷ Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Ireland.

PMID: 34083024
DOI: 10.1016/j.injury.2021.05.032

Abstract

Background: The construction of a new tertiary children's hospital and reconfiguration of its two satellite centres will become the Irish epicentre for all paediatric care including paediatric trauma. Ireland is also currently establishing a national trauma network although further planning of how to manage paediatric trauma in the context of this system is required. This research defines the unknown epidemiology of paediatric major trauma in Ireland to assist strategic planning of a future paediatric major trauma network.

Methods: Data from 1068 paediatric trauma cases was extracted from a longitudinal series of annual cross-sectional studies collected by the Trauma Audit and Research Network (TARN). All paediatric patients between the ages of 0-16 suffering AIS ≥2 injuries in Ireland between 2014-2018 were included. Demographics, injury patterns, hospital care processes and outcomes were analysed.

Results: Children were most commonly injured at home (45.1%) or in public places/roads (40.1%). The most frequent mechanisms of trauma were falls <2 m (36.8%) followed by RTAs (24.3%). Limb injuries followed by head injuries were the most often injured body parts. The proportion of head injuries in those aged <1 year is double that of any other age group. Only 21% of patients present directly to a children's hospital and 46% require transfer. Consultant-led emergency care is currently delivered to 41.5% of paediatric major trauma patients, there were 555 (48.2%) patients who required operative intervention and 22.8% who required critical care admission. A significant number of children in Ireland aged 1-5 years die from asphyxia/drowning. The overall mortality rate was 3.8% and was significantly associated with the presence of head injuries (p < 0.001).

Conclusion: Paediatric Trauma represents a significant childhood burden of mortality and morbidity in Ireland. There are currently several sub-optimal elements of paediatric trauma service delivery that will benefit from the establishment of a trauma network. This research will help guide prevention strategy, policy-making and workforce planning during the establishment of an Irish paediatric trauma network and will act as a benchmark for future comparison studies after the network is implemented.

Keywords: Emergency medicine; Healthcare systems; Major trauma network; New children's hospital; Paediatric trauma; Trauma services.

MeSH terms

Accidental Falls
Adolescent
Child
Child, Preschool
Craniocerebral Trauma*
Cross-Sectional Studies
Emergency Medical Services*
Hospitalization
Humans
Infant
Infant, Newborn
Wounds and Injuries* / epidemiology
Wounds and Injuries* / therapy