(Case 2) Management of Pediatric Trauma Patients: Optimal Care in Every Facility

Case Study #2: 

2 yo polytrauma, critically ill child, initially at community hospital, then transferred to an adult level 1 center that sees a fair amount of pediatric patients, but is not a verified pediatric center. Child was stabilized and sent to CT, which showed a grade 5 liver lac. Failed NOM in PICU and needed emergent OR for hepatic resection and vascular repair of portal vein, which had a good outcome.

Discussion on whether the child should have gone to nearest peds trauma center vs the adult level I –

• Would the care have been different?
• For severe injuries, are kids and adults really different?
• They received excellent care at adult center. Pediatric surgeons are not involved at all since adult surgeons manage all the trauma there – do they need to be?
• Adult trauma surgeons have more operative trauma experience. Should they have privileges at children’s hospitals?
• What should level 2/3 adult centers have to take care of kids in rural areas?