Referral to Pediatric Center

Pediatric trauma centers are designed to provide optimal care to pediatric trauma patients by having all pediatric specialties immediately available to the children. This is a capability-oriented approach. Designation of the trauma center is done by the state government, and the requirements vary from state to state. Several capabilities would be ideal for the pediatric trauma center.12 The hospital should have a dedicated pediatric trauma service directed by a pediatric trauma surgeon. Comprehensive pediatric services should be available from scene care to rehabilitation and reintegration into the family and society. The trauma team should be immediately available at all times and be capable of treating at least two patients simultaneously. Other pediatric specialists should be on site or immediately available including emergency medicine, anesthesiology, neurosurgery, radiology, orthopedics, pediatric intensive care, and nursing. A pediatric intensive care unit is essential.

Use of trauma triage scores can help identify a child who needs a more experienced team for care. However, not all systems are easy to use. Two common scores used are the pediatric trauma score (PTS) and revised trauma score (RTS) (T.§b!e 2.44-2.). Advantages of these scores over other systems are that they include physiologic variables instead of relying only on anatomic variables. Higher numbers are associated with a higher likelihood of survival and, thus, a reduced need for trauma center care. A child with an RTS of less than 12 or a PTS of less than 8 should be taken to a trauma center.

TABLE 244-2 A. Pediatric Trauma Score B. Revised Trauma Score

Some indications for transfer to a pediatric trauma center are listed in Iable244:3.

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