First responder performance in pediatric trauma: A comparison with an adult cohort*

Abstract

Is the prehospital care of injured children comparable with adult standards? This question has been asked repeatedly by many clinicians, yet there are no definite answers. To evaluate the prehospital care provided by first responders to pediatric patients (12 yrs of age) to determine whether the emergency medical services providers are able to adequately assess the children and provide emergency services comparable with adult standards. A retrospective 4-yr review of pediatric (n = 102) and adult (n = 99) patients with head injury and Glasgow coma scale score <15 who were treated at a level 1 trauma center. Emergency medical service interventions such as intravenous access, endotracheal intubation, and fluid resuscitation were reviewed. Patients who required further intervention on arrival at the trauma center either from nonperformance of a required procedure or complications arising from such procedures were documented. There were 102 pediatric and 99 adult patients included in the final analysis. Injury severity based on Glasgow coma scale score was not different between the groups. A total of 91 patients, 52 adults (52.5%) and 39 children (38.2%), needed endotracheal intubation at the scene. Significantly more pediatric patients had problems with intubation, 27 children (69.2%) vs. 11 adults (21.2%), p < .001.Intravenous access was successfully established in 85.9% of adults compared to 65.7% in children at the scene (p = .001). Consequently, on arrival at the trauma center, more children required intravenous access, 80.4% compared with 63.6% for adults (p = .011). As a result, more children (25.5%) required initial or additional fluid bolus at the trauma center compared with adults (9.1%, p = .003). Prehospital care of children is suboptimal compared with adults in areas of endotracheal intubation, establishment of peripheral intravenous access, and fluid resuscitation.