Send severely head-injured children to a pediatric trauma center.
Between 1985 and 1988, a total of 1,320 head-injured children were seen by the neurosurgical service at the Children's Hospital in Washington, D.C. (CHOW). This included 1,095 minor injuries, 127 moderate injuries, and 98 severe injuries. Children brought from the scene of an accident were considered direct transports, whereas those taken to another hospital prior to transfer to CHOW were indirect. Of the children that suffered severe head injuries, 56 were admitted directly to the hospital and 42 indirectly. The indirect group had a higher percentage of children with lower coma scores and abused children. The trauma score was significantly higher in the direct group (9 vs. 7). The mortality rate for severe injuries referred directly from the scene of the accident was 26.8%, and the mortality rate for children referred indirectly was 50.0%. The higher number of abused children in the indirect group did not account for the increase in mortality rate (p = 0.021) in this group. This is the first study to show that children brought directly from the scene of an accident to a well-established pediatric trauma center have a significantly better chance of survival than children transported first to the nearest available hospital.