Format

Send to

Choose Destination
An Pediatr (Barc). 2017 Dec;87(6):337-342. doi: 10.1016/j.anpedi.2017.02.007. Epub 2017 Apr 18.

[Quality of initial trauma care in paediatrics].

[Article in Spanish]

Author information

1
Servicio de Cirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España. Electronic address: ibanez_vic@hotmail.com.
2
Unidad de Cuidados Intensivos Pediátricos, Servicio de Anestesiología, Hospital Universitario y Politécnico La Fe, Valencia, España.

Abstract

INTRODUCTION:

Trauma care in Spain is not provided in specific centres, which means that health professionals have limited contact to trauma patients. After the setting up of a training program in paediatric trauma, the aim of this study was to evaluate the quality of the initial care provided to these patients before they were admitted to the paediatric intensive care unit (PICU) of a third level hospital (trauma centre), as an indirect measurement of the increase in the number of health professionals trained in trauma.

MATERIAL AND METHODS:

Two cohorts of PICU admissions were reviewed, the first one during the four years immediately before the training courses started (Group 1, period 2001-2004), and the second one during the 4 years (Group 2, period 2012-2015) after nearly 500 professionals were trained. A record was made of the injury mechanism, attending professional, Glasgow coma score (GCS), and paediatric trauma score (PTS). Initial care quality was assessed using five indicators: use of cervical collar, vascular access, orotracheal intubation if GCS ≤ 8, gastric decompression if PTS≤8, and number of actions carried out from the initial four recommended (neck control, provide oxygen, get vascular access, provide IV fluids). Compliance was compared between the 2 periods. A P<.05 was considered statistically significant.

RESULTS:

A total of 218 patient records were analysed, 105 in Group 1, and 113 in Group 2. The groups showed differences both in injury mechanism and in initial care team. A shift in injury mechanism pattern was observed, with a decrease in car accidents (28% vs 6%; P<.0001). Patients attended to in low complexity hospitals increased from 29.4% to 51.9% (P=.008), and their severity decreased when assessed using the GCS ≤ 8 (29.8% vs 13.5%; P=.004), or PTS≤8 (48.5% vs 29.7%; P=.005). As regards quality indicators, only the use of neck collar improved its compliance (17.3% to 32.7%; P=.01). Patients who received no action in the initial care remained unchanged (19% vs 11%%; P=.15).

CONCLUSIONS:

Although there are limited improvements, the setting up of a training program has not translated into better initial care for trauma patients in our area of influence. Trauma training should be complemented with other support measures in order to achieve a systematic application of the trauma care principles.

KEYWORDS:

Advanced trauma life support care; Calidad asistencial; Centro de trauma; Injuries; Lesiones; Patient simulation; Quality of healthcare; Simulación con pacientes; Soporte vital avanzado en trauma; Trauma centres

PMID:
28431900
DOI:
10.1016/j.anpedi.2017.02.007
Free full text

Supplemental Content

Full text links

Icon for Ediciones Doyma, S.L.
Loading ...
Support Center