Vaikų sunkių traumų skubiosios pagalbos veiksnių įtaka traumų išeitims ; The impact of emergency care on severe pediatric trauma outcomes

Abstract

Trauma is the main cause of death in paediatric population worldwide. Lithuania has the highest trauma-related mortality in the European Union (EU). Lithuanian standardised injury death rate is 150.9 per 100000 inhabitants while in comparison the mean standardised injury death rate in the EU is 41.4, and the lowest one is in the Netherlands (26.4 injury death rate per 100000 inhabitants). The aim of this study was to analyze the impact of pre-hospital and in-hospital emergent trauma care on severe pediatric trauma outcomes, performing a prospective observational clinical trial in the Vilnius University Children's Hospital and Vilnius Pre-hospital Emergency Service Center. Trauma registry fields were defined in details and validated during this study. The recommended quality indicators were defined and used for pre-hospital pediatric trauma care and in-hospital emergent management evaluation. The study results showed that the level of pre-hospital care is associated statistically significantly with trauma outcomes: higher pre-hospital care level caused better trauma outcome assessed according to the Glasgow Outcome Scale. The longer time until the first key emergency intervention in hospital was associated statistically significantly with the worse trauma outcomes. Calculation of the Probability of survival (Ps) according to Trauma Score Injury Severity Score model (TRISS) revealed unexpected death (Ps > 50 %) rate 74%. The reasons for fatal outcome in the patient group with the survival probability over 50% should be further investigated.