General trauma in a pediatric emergency department: Spectrum and consultation patterns

Abstract

To assess the consultation patterns of pediatric emergency physicians in the management of injured children and to describe the spectrum of pediatric trauma, we retrospectively reviewed 601 patients treated in the emergency department for injuries during four one-week periods at a designated level I regional pediatric trauma center (50,000 patients/year) with a pediatric emergency medicine fellowship. The majority (94%) of pediatric trauma was minor; only 2% of children had injuries severe enough to require direct transfer to the operating room. The highest volume of patients, the greatest number of consultations, and the majority of admissions to the operating room occurred between 4 PM and midnight. No patients went to the operating room on the night shift. Musculoskeletal injuries constituted the predominant category of pediatric trauma, and lacerations were the most common specific injury. One half of all procedures involved laceration repair, and one third involved splinting or casting. Four hundred ten patients (68%) were managed by physicians in the emergency department without consultation. The orthopedic service performed one half of all consultations and admitted the largest number of patients; the majority of patients taken directly to the operating room had musculoskeletal injuries. We conclude that most children with trauma can be managed by pediatric emergency physicians, that consultation is needed most often from general, plastic, and orthopedic surgery and neurosurgery, that pediatric emergency medicine fellowships must continue to emphasize skills in orthopedics and wound management as part of their required curricula, and that appropriate staffing to accommodate the high volume of trauma on the evening shift and the low volume on the night shift would maximize available resources and personnel.