Pediatric trauma patients in Swedish ambulance services -a retrospective observational study of assessments, interventions, and clinical outcomes

Larsson, Glenn; Larsson, Sanna; Strand, Viktoria; Magnusson, Carl; Hagiwara, Magnus Andersson · 2024 · DOAJ

DOI: 10.1186/s13049-024-01222-0

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Summary

This retrospective observational study investigates the prevalence, prehospital assessments, interventions, and clinical outcomes of pediatric trauma patients within Swedish Emergency Medical Services (EMS). The research addresses a significant gap in knowledge regarding pediatric trauma care in Sweden, where existing data primarily focuses on severely injured children and lacks comprehensive information on prehospital interventions for the broader pediatric trauma population. Given that trauma is a leading cause of death and disability among children, and previous studies have identified challenges in prehospital pediatric care, this study aims to characterize the full extent of pediatric trauma interactions with EMS to identify areas for improvement. The study analyzed a random sample of ambulance and hospital records from 2019 in a region of Southwestern Sweden. The inclusion criteria comprised children aged 0–16 years who were involved in trauma and assessed by EMS clinicians. From a total of 26,697 trauma-related assignments, a random sample of 5,500 records was drawn, resulting in the inclusion of 440 pediatric patients. Data were retrieved regarding patient demographics, injury mechanisms, vital signs, adherence to the ABCDE assessment structure, interventions performed, and clinical outcomes. Statistical analysis included descriptive statistics and Fisher’s exact tests to compare age groups. The results indicated that pediatric trauma cases accounted for 8.4% of all trauma cases, with a median age of 9 years and 60.5% male participants. The leading mechanisms of injury were low-energy falls (34.1%) and high-energy falls (20.5%), followed by traffic accidents. Only 4.5% of patients were assessed as having life-threatening conditions. A notable finding was that 29.3% of children had complete vital signs assessed, with blood pressure being the least recorded parameter (35.5%). Adherence to the ABCDE assessment structure was higher at 81.8%, but significantly lower in children aged 1–5 years. Medication administration, particularly analgesics, was the most common intervention. Regarding outcomes, 67% of patients were transported to emergency departments, while 25% remained at the scene. The mortality rate was 0.2%, with one death recorded. The study concludes that while pediatric trauma represents a substantial portion of EMS workload, assessment practices vary significantly by age, with younger children receiving less comprehensive vital sign monitoring. The high rate of patients remaining at the scene warrants further investigation for patient safety implications. The findings highlight the need for improved training and standardized assessment protocols, particularly for children aged 1–5 years, to ensure consistent and thorough prehospital care. The study underscores the importance of addressing disparities in assessment adherence to enhance the quality of pediatric trauma care in prehospital settings.

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• incidence prevalence