Research

EXECUTIVE SUMMARY OF THE FINDINGS FROM THE PILOT STUDY ON A PEDIATRIC TRAUMA REGISTRY IN GREECE

This executive summary aims to give a short overview of the pilot study on creating a pediatric trauma registry in Greece conducted by the non governmental organization “Pediatric Trauma”.

This feasibility study for the creation of a pediatric trauma registry in Greece was co-funded by the Ministry of Health and Social Solidarity under the Work Programme “Health and Welfare 2000-2006”.

STUDY DESCRIPTION AND METHODS

The study was conducted in three major cities in Greece and in general hospitals accepting pediatric patients for the periods shown below 
Athens (Gen. Pediatric Hospital “Ag. Sophia” from 15/10/07- 31/08/08)
Patras (Gen. University Hospital at Rio from 01/01/08- 31/08/08)
Thessaloniki (Gen. Hospital “G. Gennimatas” from 01/02/08-31/08/08). 

The inclusion criteria used for this study were: 
age <18yrs 
admission >24hrs 
admission diagnosis: trauma, near drowning or burn 

For the purposes of the pilot study a number of pediatric surgery residents were employed by our organization in order to track and report pediatric trauma cases. For each case fulfilling the above inclusion criteria, a registry form was completed and the data were input in an electronic SPSS database. We need to mention here that the Greek Emergency Departments (EDs) do not function as independent hospital departments with dedicated medical staff as is the case in the UK and USA, as well as other EU countries. 

STUDY RESULTS

A total of 809 pediatric cases were reported by the data collecting staff (49% from Athens, 42% from Thessaloniki and 10% from Patras). 

From the number of Emergency Department (ED) visits it seems that trauma admissions represent between 7-10% of pediatric surgery admissions and they also do not seem to have a seasonal fluctuation unlike the total number of pediatric surgery visits, which increase dramatically in late spring and summer. This fact can be interpreted to mean that serious trauma represents a small amount of the total cases presenting in a hospital but it is more or less stable, which requires a constant state of awareness on the part of the surgery staff. 

Boys represent the majority of trauma patients (66.6%) and sex is statistically significantly connected with the mechanism of trauma (more frequent athletic injuries, as well as chest and abdominal trauma). 
Eighty-one percent (81,3 %) of the trauma cases in our pilot study represented blunt trauma, which was mostly falls (50,8%) followed by traffic-related accidents (20,6%),  and 97,3% was characterized as accidental. Head injuries (26,7%) represent the most frequent admission diagnosis for trauma, followed by upper extremity fractures. Multiple injuries and internal organ injuries representing true trauma patients accounted for about 5% of the cases (5,3%), percentage which is similar to other European studies. 

Thirty seven percent (37%) of pediatric burn patients in our pilot study had parents with elementary educational level. Also 66,7% of pediatric patients who were injured in a car accident, did not have any safety measure like car seats, safety belts etc. 

More than 50% of serious accidents resulting in admission according to our data happen in the so-called “safe” areas (home 42,5% and school 10,4%) and more than 65% of serious accidents happen during spring and summer months, explained by the increased free time and outdoor activities of children at these times of the year. to the contrary 44% of burns happen during winter time. 

Unfortunately in almost three quarters of the cases (74,4%) no medical action was taken at the accident site, and minimal procedures (peripheral IV and IV fluids, followed by splinting and laceration cleaning) were done in the ED. Also interesting is the fact that the vast majority of pediatric trauma cases were transported by private vehicle (68,9%) and not by Emergency Medical Services (EMS). 

Eighty seven percent (87%) of the cases in our study had a Pediatric Trauma Score between 9-12, which represent in fact mild trauma non life-threatening trauma, and only 0,7% had a PTS in the range of 0-5 (life threatening trauma). 

More than ninety percent (91,1%) of cases were admitted to a pediatric surgery ward and only 8,2% were taken immediately to surgery. 88,8% of patients had no complications during their hospital stay, which was an average of 2,2 days duration, and 97,8% of patients exited were released to their parents to go home.   

STUDY WEAKNESSES

Acceptance of the study and its objectives by the medical community of the participating hospitals 
Delays in following the procedures set by each hospital for obtaining permission to start the pilot study. Resulted in delays and varying starting dates for the three participating hospitals which makes comparison difficult. 
The need to employ pediatric surgery residents from the involved hospitals in order to have access to the medical records. Resulted in increased cost of this pilot study. 
Registering Dead-on-Arrival (DOA) cases and in general deaths. It seems that these cases follow different “pathway” in the hospital and are not registered centrally.  
Obtaining the necessary numbers of 
total ED visits and visits per specialty, 
total admissions and admissions per specialty. For the metro Athens area some data is kept by the National Health Operations Centre of the Ministry of Health. For the rest of the country no real central registration exists for the ED visits.
Inclusion criterion of admission of 24-hr duration. This resulted in having registered many mild trauma cases. Probably admission duration of 48-hrs is necessary. 
Inclusion criterion of age<18: not possible to register adolescents who are taken to adult general hospitals. 


STUDY CONCLUSIONS

For the Trauma Registry and the Emergency Response System in general 
1) The feasibility study was successful. A Pediatric Trauma Registry is certainly feasible in Greece under certain conditions. 
2)  This reporting and registry should be continued under a central coordinating structure and should include other agencies (e.g. EMS and Forensic Services) 
3) Some re-evaluation of the inclusion criteria should be done in order to accurately register true trauma cases.
4) Continuing training and education of ED staff should be enhanced, as far as pediatric cases are concerned. 
5) Central registration of all incoming patients in the pediatric hospitals needs to be promoted and certainly necessary budget should be allocated. 
6) Central triaging is vital for the proper function of a pediatric ED. 
7) Adolescent medicine departments were announced by the Greek Ministry of Health but they need to be materialized 
8) Training on the special needs of the adolescent patients should be undertaken for all surgical specialties. 
9) Training of the EMS personnel on the management of pediatric trauma cases is needed. The Greek EMS does not transport children on a regular basis but it is called upon to transport (by ambulance or airplane) the very serious cases. 
10) Clinical management guidelines for head injuries are needed in order to avoid the largest burden of admissions for observation.

For the Prevention of trauma and the relevant health promotion activities 
1) Need for targeting boys of school age. 
a. Specific review of the material on accident prevention to make sure it targets boys of school age. 
b. Information to parents and pediatricians on the need for attention to this age group 
2) Appropriate education material is needed for the prevention of burns (e.g. use of pictograms etc, as a large percentage of the parents of the children who suffer burns have elementary education level) 
3) Need for continuing and aggressive health promotion on the subject of traffic-related accidents (children as passengers or pedestrians). 
a. Collaboration with other agencies beyond the health sector is needed

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