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THE TRAUMA AUDIT AND RESEARCH NETWORK

4

2Years of Severe Injury in Children

Summary

During January 2013 to December 2014 there were 1,511 severely injured children treated in England &Wales. Road traffic

incidents and resulting head injuries still predominate as the major causes of severe injury and mortality; however, as a

proportion of injury mechanisms, asphyxia and drowning have the highest percentages for death.This is shown in the new

data on the injury mechanisms (Page 8) and in the breakdown of patients injured in road traffic incidents (Page 9). Many of

the same data sets that were provided in the 2012 report have been repeated so allowing for comparisons over time to be

made.These are detailed below.

Other additional data sets have been included in the 2013-14 report, for example a new feature is the division of the injury

type from 3 categories in 2012 to 6 which separates out polytrauma, spinal injury, and divides the previous category of

thoracic/abdominal into 2 distinct categories (Page 10).

Additional data sets include:

1. The numbers and proportion of children with definitive airway management (and where this occurred)

2. When a definitive airway was secured

3. The length of stay in hospital

4. Mortality data where cause of death was known

5. The most severe injury pattern associated with the death

6. Interaction of injuries with the risk of mortality

7. The grade of surgeon involved with operations

As trauma systems evolve and mature there will be changes in the way in which the healthcare system responds to severely

injured children. The TARNlet reports will aim to present the best information that is available about our care of children

and young people and strive to produce data that will assist in the improvement of the delivery of trauma services. The

addition of these new data sets in this report will allow for greater comparison in future reports on progress made in

paediatric trauma management.

COMPARISONS OF 2012WITH 2013-14

The data from 2013-14 shows many similarities with 2012, with an improved completeness of data returned by TARN

involved hospitals, from 73.7% to 80.7%.

The number of severely injured children is similar on a yearly basis, with a similar picture of seasonality (fromApril to

October) and with more cases occurring at weekends and in the afternoon and evenings.The pattern of arrival of severely

injured children implies that staffing for paediatric trauma needs to be matched to a pattern that includes high rates of

arrival outside the conventional working day (especially in the evening and at weekends), and low rates of arrival after

midnight. This may play a part in resource implications for Major Trauma Centres in terms of staffing, but nonetheless,

optimally trained staff should be available to ensure the best care that can be given.

It is still worrying that about 25% of severely injured children are taken by transport means other than ambulance or

helicopter, meaning that many parents/carers are taking these children to Trauma Units, so adding to the delay for definite

treatment to be delivered.Trauma systems need to anticipate that children will continue to arrive at Trauma Units or non-

designated hospitals and have systems to ensure that children are not disadvantaged by initially presenting to the “wrong”

hospital.There is a public health message that needs to get to parents and carers about the trauma network; time to definite

treatment may be reducible in severely injured children by the use of prehospital triage systems. Staff in all hospitals need

sufficient ongoing training to enable them to provide initial care until either a specialist team arrives or an inter-hospital

transfer is carried out. The data showed that most severely injured children are moved to a specialist Trauma Centre, which

emphasises the need for a prompt inter-hospital transfer system.