Aims, Objectives and BackgroundIn the UK over half of severely injured children are conveyed to a trauma unit (TU). A proportion of these are subsequently transferred to a major trauma centre (MTC). Most regional networks permit TU bypass to an MTC. However, data on patient-centered outcomes between models are limited. The objective of this study was to compare hospital and intensive care unit (ICU) length of stay (LOS) between bypass and secondary transfer cohorts.Method and DesignAll paediatric trauma patients (meeting Trauma Audit Research Network (TARN) inclusion criteria) admitted to the East of England MTC (2015–2020) were included. Bypass was defined as >45min transport time to MTC; secondary transfer was defined as transfer from a TU <24hr. TARN data were cross-referenced with electronic patient records to link pre-hospital data, complications, and timings. Data are reported as number (percentage), and median [inter-quartile range]. Proportions were compared with a Fisher’s exact test, and medians with a Mann-Whitney U test; reported a p-values. Data were analysed in Prism 9 for macOS.Results & ConclusionA total of 232 patients (n=58 bypass, n=174 secondary transfer) were included. The median age was 9.8 [4.5–13.7] years, n=156 (67.2%) were male, and the median injury severity score was 17.0 [10.0–25.0]; not significantly different between groups, table 1. The median time to definitive care was five hours greater in the TU cohort, table 1.There was a significantly longer hospital LOS and ICU LOS in the bypass group, both p<0.001.We observed no difference in mortality at time of discharge between groups, but the secondary transfer cohort were more likely to have a good neurological recovery, table 1.Abstract 1665 Table 1Comparison of Bypass and Secondary Transfer cohorts, n= 232BypassSecondary Transfern58174-Age (years)/median [IQR]9.4 [5.3–13.5]10.0 [3.8–13.7]p=0.73Male sex/n (%)37 (63.8%)119 (68.4%)p=0.52ISS/median [IQR]20.0 [10.8–29.0]16.0 [10.0–25.0]p=0.067Pre-hospitalMTTT +/n (%)55 (94.8%)28 (16.1%)p<0.0001HEMS team/n (%)54 (93.1%)21 (12.1%)p<0.0001Time to MTC (minutes)/median [IQR]117.6 [100.8–136.8]418.8 [315.6–529.8]p<0.0001MTCTrauma team reception/n (%)48 (82.8%)60 (34.5%)p<0.0001OutcomesGOS 1 (death)/n (%)3 (5.2%)7 (4.0%)p=0.71GOS 2/n (%)00-GOS 3/n (%)4 (6.9%)1 (0.6%)p=0.02GOS 4/n (%)21 (36.2%)28 (16.1%)p=0.003GOS 5 (good)/n (%)31 (53.4%)137 (78.7%)p=0.0003LOS (days)/median [IQR]8.5 [6.0–19.0]5.0 [3.0–10.0]p<0.0001ICU admit/n (%)48 (82.8%)126 (72.4%)p=0.16ICU LOS (for admits) (days)/median [IQR]2.0 [1.0–6.0]1.0 [1.0–3.0]p=0.0006*Major complication/n (%)6 (10.3%)19 (10.9%)p>0.99Abbreviations GOS = Glasgow Outcome Score ICU = Intensive Care Unit ISS = Injury Severity Score IQR= Interquartile Range LOS = Length of stay MTTT = Major Trauma Triage Tool MTC = Major Trauma Centre TU = Trauma Unit*Major Complication = Occurrence of any of the following during admission: pneumonia, PE, ARDS, sepsis, post-op complication, post-op haemorrhage, convulsion, CNS infection, wound dehiscenceIn this regional study of paediatric trauma, we found no evidence that bypass to an MTC was associated with better patient outcomes compared to secondary transfer, despite significant time delays in reaching definitive care.

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Aims, Objectives and BackgroundAppropriate and timely imaging improves trauma outcomes. In adults, the default is whole-body computed tomography (CT). However, in children more selective imaging should be used. In those requiring CT, the national standard is imaging ≤30mins of arrival. The aims of this study were to compare appropriateness of CT and time to initial CT in paediatric trauma patients conveyed directly to a major trauma centre (MTC) with those initially treated in a trauma unit (TU) and then transferred to an MTC.Method and DesignA retrospective observational study in the East of England MTC (2015–2020). All paediatric trauma patients meeting Trauma Audit Research Network (TARN) criteria who arrived at the MTC ≤24hr of injury and underwent CT imaging within 12 hours of arrival were included.Data were obtained from the MTC trauma office and clinical records were independently reviewed by two authors. The Royal College of Radiologists guideline for paediatric trauma was used to assess the appropriateness of the CT imaging strategy.„Combined data were stored in a Microsoft Excel sheet and analysed in Prism 9 for macOS (GraphPad). Data are reported as number (percentage), and median [inter-quartile range]. Proportions were compared with a Fisher’s Exact test; differences between median values were compared with a Mann-Whitney U test.Results and ConclusionIn the study period n=315 patients were identified. 229 (72.7%) underwent CT <12hrs and were included in the analysis: n=93 MTC, n=136 TU, table 1. CT imaging was judged as appropriate in n=77/93 (82.8%) MTC and n=104/136 (76.5%) TU scans, p=0.32. The median time to first CT was 35.0 [26.0–75.0] minutes MTC, and 76.0 [48.0–109.0] minutes TU, p<0.0001.Abstract 1657 Table 1CT appropriateness and timing associated with transfer status at a single MTCPrimary Attendance to MTCSecondary Transfer to MTCCT <12 hours of hospital arrival/n(%)93 (41%)136 (59%)Age in years/median [IQR]9.8 [5.4 – 14.1]9.3 [3.5 – 13.8]Male sex/n (%)58 (62%)96 (71%)Injury Severity Score/median/[IQR]18 [10 – 29]16 [15 – 25]Hospital arrival to first CT interval (minutes)/median [IQR]35 [26–75]75 [47–108]CT whole body (% of CT at TU/MTC)47 (51%)47 (35%)CT focussed (% of CT at TU/MTC)46 (49%)89 (65%)CT appropriate (% of CT at TU/MTC)77 (83%)104 (76%)Abbreviations: CT = Computed Tomography; IQR= Interquartile Range; MTC = Major Trauma Centre; TU = Trauma Unit.We have demonstrated room for improvement in paediatric CT trauma imaging appropriateness across the network, but this is not significantly different between the MTC and TUs. However, time to initial trauma CT was significantly shorter in the MTC.

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