Experts: Pediatric Trauma Care System in Need of Triage

Research on how to best treat and rehabilitate seriously ill and injured children will help prioritize, support, and implement changes in care, say experts.

Although pediatric trauma is the leading cause of death and acquired disability among children and young adults in the US, many deficiencies still exist in pediatric trauma care, and there is little research nationally to address them, according to a commentary published in two academic journals.

“Despite the enormity of this public health problem, there is no comprehensive national pediatric trauma research agenda and no infrastructure to support a pediatric trauma research network,” said Peter F. Ehrlich, MD, MHS, director of Pediatric Trauma at the University of Michigan C. S. Mott Children’s Hospital, and one of the authors in the commentary. “The development of a research consortium such as a Pediatric Applied Trauma Research Network is the next logical step to address these challenges.”

The types of research conducted would be comprehensive and multi-disciplinary to include improving head injury outcomes, risk-based behavior such as substance abuse, thoracic injury, stem cells and brain injury, mental health, rehabilitation and orthopedic approaches to injured children, according to the piece, which is published in the Journal of Trauma, Injury, Infection, and Critical Care and the Journal of Pediatric Surgery.

“We’re trying to bridge a gap between a huge pediatric problem and a lack of research by the people who care for these children 90% of the time,” he said in a press release. “We’re trying to raise the profile of this problem and the understanding that not one center that can do it. It’s got be a comprehensive, multi-center effort.”

Pediatric trauma affects both genders and all economic, racial, and social backgrounds in the US, and can impact not only the physical well-being of the child, but also his or her mental health and school performance, and the well-being of the child’s family.

A busy urban pediatric emergency department may see 50,000 to 70,000 patients per year, of which only 10% are injured, and roughly 10% of the injured group is admitted to the hospital. In a moderate-sized city with a 500,000 population and 125,000 children, 375 children per year are hospitalized for the treatment of any injury, of which only 20 to 40 have sustained a severe injury.

Because the number of seriously injured children treated at a single center is relatively small, a research network is required for studies focused on severe pediatric injury. Individual institutions are also unlikely to have sufficient patient diversity to represent all populations, such as rural, suburban, minority, or low socioeconomic status.

The authors propose that the research network include thought leaders from Level 1 pediatric trauma centers from across the country working to determine a research agenda, research infrastructure, resources, tools and methodologies for studying pediatric trauma.

The network—fueled by federal resources—would create approaches for measuring health care delivery, according to the authors. The framework would include the entire continuum from injury prevention to rehabilitation.

Access to injured children in pre-hospital, in-hospital, and post-hospital settings will allow the network to address a range of research issues including the pre-hospital and hospital triage of injured patients, airway management, acute care and rehabilitation of children with traumatic brain injury, the role of blunt and penetrating abdominal trauma, identification and treatment of alcohol and substance abuse, and the development of targeted injury prevention programs.

Experts are calling for additional research to help mend the problems that exist in pediatric trauma care, but is that enough to fix the situation?