PREHOSPITAL CARE AND SURVIVAL OF PEDIATRIC-PATIENTS WITH BLUNT TRAUMA

Background: The aim of this study was to compare the outcome of severe blunt trauma in children receiving prehospital care from either physi cian-staffed advanced life support (ALS) units, or from basic life sup port (BLS) units staffed by emergency medical technicians. Methods: Th e records of 288 children with severe blunt trauma who required intens ive care in the regional level 1 trauma center or who died from their injuries were analyzed retrospectively. Patients were excluded if resu scitation at the scene was not attempted, if the level of prehospital care was unspecified, or if arrival at the level 1 trauma center was d elayed beyond 150 minutes. Seventy-two patients met the inclusion crit eria of BLS-, and 49 the criteria of ALS-prehospital care. Results: A reduced mortality rate (22.4% v 31.9%) was seen in the ALS group, whic h was more apparent in a ''salvageable but high-risk'' subgroup, chara cterized by Glasgow Coma of Scale 4 through 8, Pediatric Trauma Score of 0 through 5, and Injury Severity Score (ISS) of 25 through 49. Howe ver, a statistically significant difference was only seen when trauma severity was evaluated by the ISS. Conclusion: An improved outcome in children with severe blunt trauma has been demonstrated when prehospit al care is provided by physician-staffed ALS units compared with BLS u nits. Copyright (C) 1998 by W.B. Saunders Company.