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Does referral to a paediatric trauma unit affect outcome?

Elisabeth Boddé, Monique van Dijk, Arjan Bastiaan van As

Background: There has been much debate in international literature about whether it is better to treat trauma patients at the injury site, at a nearby facility, or to transport them to a specialized emergency health care facility. Previous studies comparing directly admitted and referred patients showed contradicting results and very few studies focused on children. The aim of this research was to obtain an overview of the potential differences in outcome between directly admitted and referred patients in the setting of the Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Methods: A 5-year retrospective medical folder audit was conducted of 209 children admitted to the Red Cross War Memorial Children’s Hospital with an abbreviated injury score of three or four. We compared outcomes between directly admitted patients and patients referred from other health institutions. Results: There was no difference in mortality or length of stay of the patients in the Red Cross War Memorial Children’s Hospital. Directly admitted patients reached the hospital within a median of 60 minutes (interquartile range, IQR, 52 to 84) compared to 185 minutes (IQR 120 to 302) for referred patients (p<0.01). Conclusions: To shorten delay time for referred patients, the on-field triage system needs to be improved. Also, ambulance personnel need to be trained to perform treatments on site, to replace an initial non-trauma hospital, and transport patients directly to a specialized emergency health care facility.