Paediatric trauma in Spain:: A report from the HUGM trauma registry

Objectives: To analyse the characteristics of the infant population suffering trauma in our setting. To evaluate the importance of the different aetiological mechanisms. To study the pre- and intra-hospital management of these children. To describe the relative significance of the different lesions. To establish the magnitude of paediatric trauma as a social problem in terms of morbidity and mortality. Material and Methods: From January 1995 to April 2002, a total of 2633 children admitted to our Centre (Hospital Universitario Gregorio Maranon) after suffering some type of injury were included in our Trauma Register. 108 variables have been analysed, including the identification of the patient, type, site and mechanism of the accident, pre-hospital care, transport, complete evaluation on admission, indices of injury severity, diagnostic tests, lesions, treatments performed and morbidity and mortality. Results: The accidents were more frequent in boys than in girls (68.5% versus 31.5%). The predominant age group was the 12-15 year old group (36.8%). There was a higher frequency of accidents in the street (37.2%) than at home (19.4%) or at school (13.8%). The most frequent mechanism was a fall (35.6%), followed by road traffic accidents (23.7%). On admission, 14.7% of the children had a Paediatric Trauma Score (P.T.S.) <= 8 (n = 388). 3.8% were considered severe multiple trauma patients, presenting an Injury Severity Score (I.S.S.) >= 15 (n = 101). 4.2% of the children required intensive care. The most frequent lesions were those of the locomotor system (58.1%) and head injuries (34.9%). Some type of surgical or orthopaedic procedure was performed under general anaesthesia in 1522 patients (57.8%). The mean length of stay was 4.4 days (range 1 - 214 days). Sequelae of some form were detected in 36.4% of the patients over 3 years of age. The total mortality was 0.5% (n = 13), being 12.8% in the group of patients with an I.S.S. >= 15. Conclusions: Analysis of the data in our Registry has helped us to define the characteristics of the paediatric trauma population in our setting, to monitor the management of trauma in the different care levels and to develop prevention programmes. It has also enabled us to compare the results with those of other centres in terms of morbidity and mortality with the aim of identifying and correcting any possible deficiencies in the care system.