RESUMEN
OBJECTIVE: To study the epidemiology and management of pediatric trauma patients as well as the organizational, human and technical resources dedicated to these children from the perspective of the pediatric intensive care unit (PICU). MATERIAL AND METHODS: A standardized data collection form was sent to 43 PICUs in Spain. Items inquired about the existence of training courses, trauma clinical practice guidelines and trauma registers, and which physician was in charge of trauma patients. Data on casuistics, the age of trauma patients, and the availability of human and technical resources, were also recorded. RESULTS: Twenty-four PICUs completed the questionnaire. The PICU physician was responsible for trauma patient care in 66% of the hospitals. No training courses were available in 59% of the hospitals. No trauma register was available in 62% of the hospitals. Trauma patients represented 11% of PICU admissions, and most patients were aged up to 14 years old. An anesthetist was always at the hospital in 100% of the hospitals. A radiologist and traumatologist were always at the hospital in 91%, a neurosurgeon in 66% and a pediatric surgeon in 50%. The remaining surgical and medical specialties were on call. Continuous intracranial pressure monitoring was available in 87% of the PICUs, jugular venous saturation monitoring in 54% and continuous electroencephalogram and transcranial Doppler ultrasound in 50%. Computed tomography and ultrasound were available at all times in all hospitals. Magnetic nuclear resonance and echocardiography were available at all times in 44% of the hospitals, and arteriography in 42%. CONCLUSION: In Spain, the organization of pediatric trauma management is based on pediatric teams under the supervision of a PICU physician. Some hospitals show a lack of technical and human resources. Therefore, the minimum criteria required to consider a hospital as a pediatric trauma center should be established. Trauma training courses are required.
Asunto(s)
Unidades de Cuidado Intensivo Pediátrico/organización & administración , Traumatismo Múltiple/terapia , Centros Traumatológicos/normas , Adolescente , Factores de Edad , Niño , Predicción , Humanos , Monitoreo Fisiológico , Traumatismo Múltiple/epidemiología , Guías de Práctica Clínica como Asunto , España , Encuestas y Cuestionarios , Recursos HumanosRESUMEN
Objetivos Conocer la realidad de la asistencia a los pacientes traumáticos en España. Material métodos Se parte de los resultados de una encuesta a las 43 unidades de cuidados intensivos pediátricos (UCIP) acreditadas. Se preguntaba sobre la existencia de protocolos, programas y registro de traumáticos, quién era el responsable, si se impartían cursos de formación, la casuística, la edad y sus recursos humanos y materiales. Resultados Contestaron 24 unidades. En el 66 % el intensivista es el responsable de la asistencia, el 59 % no dispone de cursos de formación y el 62 % registro de trauma. Los pacientes traumáticos representaron como media el 11 % del total de ingresos y la edad comprendía mayoritariamente hasta los 14 años. El anestesista realiza guardias de presencia física en el 100 %, el radiólogo y traumatólogo en el 91 % y el neurocirujano en el 66 %. El cirujano pediátrico en el 50 %. El resto de especialidades quirúrgicas y médicas están mayoritariamente de guardia localizada. El 87 % tiene registro de presión intracraneal, el 54 % saturación de la yugular, el 50 % electroencefalograma continuo y ecografía Doppler transcraneal las 24 h. El 100 % dispone de tomografía computarizada y ecografía las 24 h, resonancia magnética ecocardiografía en el 44 % y arteriografía en el 42 %. Conclusión Se deduce que en España se ha optado por desarrollar equipos pediátricos en el marco de hospitales generales y liderados por el intensivista pediátrico. Se observa en algunos centros una carencia de recursos técnicos y materiales por lo que cabría definir cuáles son los mínimos imprescindibles para acreditar un hospital como receptor de niños traumáticos. Se aprecia una falta de programas de formación en esta materia que debería llevar a organizar cursos en este sentido
Objective To study the epidemiology and management of pediatric trauma patients as well as the organizational, human and technical resources dedicated to these children from the perspective of the pediatric intensive care unit (PICU). Material and methods A standardized data collection form was sent to 43 PICUs in Spain. Items inquired about the existence of training courses, trauma clinical practice guidelines and trauma registers, and which physician was in charge of trauma patients. Data on casuistics, the age of trauma patients, and the availability of human and technical resources, were also recorded. Results Twenty-four PICUs completed the questionnaire. The PICU physician was responsible for trauma patient care in 66 % of the hospitals. No training courses were available in 59 % of the hospitals. No trauma register was available in 62 % of the hospitals. Trauma patients represented 11 % of PICU admissions, and most patients were aged up to 14 years old. An anesthetist was always at the hospital in 100 % of the hospitals. A radiologist and traumatologist were always at the hospital in 91 %, a neurosurgeon in 66 % and a pediatric surgeon in 50 %. The remaining surgical and medical specialties were on call. Continuous intracranial pressure monitoring was available in 87 % of the PICUs, jugular venous saturation monitoring in 54 % and continuous electroencephalogram and transcranial Doppler ultrasound in 50 %. Computed tomography and ultrasound were available at all times in all hospitals. Magnetic nuclear resonance and echocardiography were available at all times in 44 % of the hospitals, and arteriography in 42%. Conclusion In Spain, the organization of pediatric trauma management is based on pediatric teams under the supervision of a PICU physician. Some hospitals show a lack of technical and human resources. Therefore, the minimum criteria required to consider a hospital as a pediatric trauma center should be established. Trauma training courses are required