Effect of a pediatric trauma response team on emergency department treatment time and mortality of pediatric trauma victims

Objective. Delay in the provision of definitive care for critically injured children may adversely effect outcome. We sought to speed care in the emer gency department (ED) for trauma victims by organizing a formal trauma resp onse system. Design. A case-control study of severely injured children, comparing those who received treatment before and after the creation of a formal trauma res ponse team. Setting. A tertiary pediatric referral hospital that is a locally designate d pediatric trauma center, and also receives trauma victims from a geograph ically large area of the Western United States. Subjects. Pediatric trauma victims identified as critically injured (design ated as "trauma one") and heated by a hospital trauma response team during the first year of its existence. Control patients were matched with subject s by probability of survival scores, and were chosen from pediatric trauma victims treated at the same hospital during the year preceding the creation of the trauma team. Interventions. A trauma response team was organized to respond to pediatric trauma victims seen in the ED. The decision to activate the trauma team (d esignation of patient as "trauma one") is made by the pediatric emergency m edicine (PEM) physician before patient arrival in the ED, based on data rec eived from prehospital care providers. Activation results in the notificati on and immediate travel to the ED of a pediatric surgeon, neurosurgeon, eme rgency physician, intensivist, pharmacist, radiology technician, phlebotomi st, and intensive care unit nurse, and mobilization of an operating room te am. Most trauma one patients arrived by helicopter directly from accident s cenes. Outcome Measures. Data recorded included identifying information, diagnosis , time to head computerized tomography, time required for ED treatment, adm ission Revised Trauma Score, discharge Injury Severity Score, surgical proc edures performed, and mortality outcome. Trauma injury Severity Score metho dology was used to calculate the probability of survival and mortality comp ared with the reference patients of the Major Trauma Outcome Study, by calc ulation of z score. Results. Patients treated in the ED after trauma team initiation had statis tically shorter times from arrival to computerized tomography scanning (27 +/- 2 vs 21 +/- 4 minutes), operating room (63 +/- 16 vs 623 +/- 27 minutes ) and total time in the ED (85 +/- 8 vs 821 +/- 9 minutes). Calculation of z score showed that survival for the control group was not different from t he reference population (z = -0.8068), although survival for trauma-one pat ients was significantly better than the reference population (z = 2.102). Conclusion. Before creation of the trauma team, relevant specialists were i ndividually called to the ED for patient evaluation. When a formal trauma r esponse team was organized, time required for ED treatment of severe trauma was decreased, and survival was better than predicted compared with the re ference Major Trauma Outcome Study population.