A Tumble, Thunk: How Serious is the Child’s Injury?
When a child wipes out while snowboarding or falls down a flight of stairs, paramedics quickly make triage decisions on site, including where to send the child for treatment. A Rochester team is studying thousands of these scenarios to learn the best practices at the scene, and what circumstances predict the need for a trauma center.
One goal is to provide criteria to guide decisions in communities across the country, said Jeremy T. Cushman, M.D., associate professor of Emergency Medicine. The results might also show paramedics and physicians how to improve survival rates while saving costs.
“We want to know how EMS providers are making their decisions,” Cushman said, “and without formal research it’s hard to gain anything more than anecdotal evidence. Kids get into things, and the outcomes can be quite different depending on age and a variety of other factors. If a child falls off a bunk bed, for instance, the injury could be more serious in a 4-year-old than an 8-year-old or 12-year-old.” (Doctors treated nearly 575,000 children for bunk-bed related injuries between 1990 and 2005 in the United States, according to the journal Pediatrics.)
Cushman is the Rochester principal investigator for the collaborative project, with the Medical College of Wisconsin and Texas Children’s Hospital. They expect to enroll more than 20,000 children younger than age 15 in the study, which was funded with a $1.5 million grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development to Wisconsin. The UR is a subcontractor; approximately 5,000 of the 20,000 patients are expected to be enrolled through UR Medicine’s Strong Memorial Hospital emergency room, beginning in March 2014.
“Field triage” is a concept championed by the Centers for Disease Control and Prevention. Injuries are the leading cause of death for people ages 1 to 44, but not all patients can or should be transported to a Level 1 trauma center, and the current system for categorizing injuries on the scene was created for adult patients.
At Strong Hospital when a child arrives for treatment, research assistants will interview the Emergency Medicine Service (EMS) provider to get accident details and factors that influenced their decisions in the field, and track the children throughout their health care experience.
Leslie Orr |
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