V. Patel1, R. Khatun1, M. Carmack2, J. Calhoun1, J. Shim1 1Bassett Medical Center, Deptartment Of Surgery, Cooperstown, NY, USA 2Columbia University Vagelos College of Physicians and Surgeon, School Of Medicine, New York, NY, USA
Introduction:
Rural hospitals cover 20 percent of the United States population with only 10 percent physician coverage. A mismatch exists in pediatric trauma resources in the United States as there is an overwhelming wealth of trauma support concentrated in the urban trauma centers. Well-established guidelines for evaluating pediatric trauma patients in resource-limited environments are currently not available. Guidelines may help prevent unnecessary computer tomography scans and, therefore, limit radiation exposure. Herein we identify the imaging practices at level three rural trauma centers, to establish a protocol.
Methods:
The National Trauma Data Bank (NTDB) was used to identify 155 pediatric trauma patients (age <17 years) who presented to our institution (2017-2021). A retrospective chart review was performed to identify patient demographics, mechanism of injury, imaging performed, and management of the patient, that is discharge, admission, and transfer to a level one trauma center.
Results:
Blunt mechanisms caused the vast majority of traumas (90%) during the 5-year period. There were 64 patients (41.3%) who received CT imaging. Falls (49.3%) and motor vehicle accidents (12.2%) were the most common mechanisms of injury. The majority of the patients (85%) were discharged home and 13% were transferred to a tertiary center. The mean time for transfer to a tertiary center was ~176mins. The most frequently performed type of surgical intervention was orthopedic (59.3%).
Conclusion:
Our level three rural trauma center utilizes an adult trauma team for pediatric trauma activations. Studies have shown that the use of CT scans has been significantly higher at adult trauma centers in comparison to pediatric trauma centers. An established pediatric trauma imaging protocol is warranted as rural hospitals will be required to adopt a higher level of pediatric trauma care for treatment and/or stabilization purposes. Using a tertiary care model and established pediatric trauma guidelines, we propose the following model for use in resource-limited rural settings (Figure 1). Using this guideline, we expect to reduce the overall radiation exposure at a resource-limited rural hospital.
