Review of paediatric trauma admissions at the Royal London Hospital (February 98 to February 99)

Abstract

An Intervention Score (I/S) was designed: 1 = no interventions and discharged day of surgery; 2 = no interventions but overnight stay in hospital; 3 = minor interventions (O 2 therapy, airway manipulation or arti®cial airway) and discharged on day of surgery; 4 = minor interventions but stayed overnight; 5 = major interventions (IPPV, reintubation, cardiac arrest or ICU admission). The I/S was further collapsed into two categories; 1 and 2 = nil interventions and 3, 4 and 5 = interventions. Results The charts of 163 children were reviewed. Twenty-eight (17.2%) had an I/S of 1, 101 (62%) had an I/S of 2, 2 (1.2%) had an I/S of 3, 21 (12.9%) had an I/S of 4 and 11 (6.7%) had an I/S of 5. Children who required interventions (I/S ³ 3) had an SaO 2 nadir of 71 plus/minus 2 versus 85 0.8 (P = 0.00), an AHI of 28 6 vs. 9 1 (P = 0.00) and a desaturation index of 26 6 vs. 7 0.8 (P = 0.00). Conclusion The post operative respiratory complications occurred more commonly in children with lower SpO 2 nadir, a higher AHI and a higher desaturation index.

The advantages of early trauma team activation in the management of major trauma patients who underwent exploratory laparotomy

“…While it is difficult to define the ideal time interval between ER arrival and emergency surgery, Western trauma centers generally define it as within 2 hours. A study of the Royal London Hospital found that the mean duration from ER arrival to emergency surgery was 56 minutes for blunt trauma and 37 minutes for penetrating trauma [ 20 ]. Another study using American College of Surgeons audit filters found that performance of laparotomy more than 2 hours after admission resulted in increased mortality and longer ICU and hospital stay [ 21 ].…”