Operative management of injured children at an adult Level I trauma center

Background: The geographic distribution of trauma centers results in a sign ificant number of children being treated in adult centers. The emphasis on nonoperative management of pediatric blunt trauma has heightened concern th at in adult trauma centers, an aggressive operative approach mill continue to be used. We hypothesized that pediatric commitment at a Level I trauma c enter results in appropriate nonoperative care of injured children as estab lished by regional pediatric trauma centers. Methods: The records of 1,792 consecutively treated children admitted to th e trauma service during a 6-year period (January of 1990 to December of 199 5) were reviewed, Patients mere stratified into one of three age groups: 0 to 5, 6 to 11, and 12 to 17 Sears of age. Results: Mean age of the study patients mas 10.0 +/- 0.1 years, 1,147 were boys (64%), and their mean Injury Severity Score was 7.3 +/- 0.3. The injur y mechanism was blunt in 1,550 (87%) and 132 (7%) required laparotomy. In t he 0- to 5-year-old blunt mechanism group, 6% underwent laparotomy or thora cotomy from 1990 to 1992, In comparison, only 1% of this age group had a la parotomy from 1993 to 1995 (p < 0.05, Fisher's exact test), A similar trend was found in the 6- to Ii-year-old children after blunt injury (4% laparot omy rate from 1990 to 1992; 2% from 1993-1995). Conclusion: There has been a declining trend in the operative management of blunt pediatric trauma, especially in children less than 6 years old, wher eas the operative management of penetrating injuries has remained stable. T hese data confirm that pediatric commitment in a Level I trauma center resu lts in nonoperative treatment of injured children commensurate with that es tablished in regional pediatric trauma centers.