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Pediatric trauma primary survey performance among surgical and non-surgical pediatric providers in a Brazilian trauma center
  1. Fabio Botelho1,
  2. Paul Truche2,
  3. David P Mooney2,
  4. Luke Caddell2,
  5. Kathrin Zimmerman2,
  6. Lina Roa2,
  7. Nivaldo Alonso3,
  8. Alexis Bowder2,
  9. Domingos Drumond4,
  10. Simone de Campos Vieira Abib5
  1. 1Cirurgia Pediatrica, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  2. 2Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Cirurgia Plastica, Universidade de São Paulo, São Paulo, Brazil
  4. 4Hospital Joao XXIII, Belo Horizonte, Brazil
  5. 5Cirurgia Pediatrica, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
  1. Correspondence to Dr Fabio Botelho; mendesbotelho{at}


Introduction Trauma is the leading cause of death and disability among Brazilian children and adolescents. Trauma protocols such as those developed by the Advanced Trauma Life Support course are widely taught, but few studies have assessed the degree to which the use of protocolized trauma assessment improves outcomes. This study aims to quantify the adherence of trauma assessment protocols among different types of frontline trauma providers.

Methods A prospective observational study of pediatric trauma care in one of the busiest Latin American trauma centers was conducted during 6 months. Trauma primary survey assessments were observed and adherence to each step of a standardized primary assessment protocol was recorded. Adherence to the assessment protocol was compared among different types of providers, the time of presentation and severity of injury. The relationship between protocol adherence and clinical outcomes including mortality, length of hospital stay, admission to pediatric intensive care unit, use of blood components, mechanical ventilation and number of imaging exams performed in the first 24 hours were also assessed.

Results Emergency department evaluations of 64 patients out of 274 pediatric admissions were observed over a period of 6 months. 50% of the primary assessments were performed by general surgeons, 34.4% by residents in general surgery and 15.6% by pediatricians. There was an average adherence rate of 34.1% to the trauma protocol. Adherence among each specific step included airway: 17.2%; breathing: 59.4%; circulation: 95.3%; disability: 28.8%; exposure: 18.8%. No differences between specialties were observed. Patients with a more thorough primary assessment underwent fewer CT scans (receiver operating characteristic curve area: 0.661; p=0.027).

Conclusions Our study demonstrates that trauma assessment protocol adherence among trauma providers is low. Thorough initial assessment reduced the use of CT scans suggesting that standardized pediatric trauma assessments may be a way to reduce unnecessary radiological imaging among children.

Level of evidence IV.

Study type Pediatric and global trauma.

  • wounds and injuries
  • child
  • education
  • clinical protocols

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  • Contributors All the author contributed with this project. FB, DD, SdCVA designed the research protocol, collected data and analyzed the results. PT, DPM, LC, LR, KZ, NA and AB helped with the discussion, manuscript writing and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was developed at Hospital João XXIII (HJXXIII), in Belo Horizonte, the capital of the Brazilian state of Minas Gerais, in partnership with the Federal University of São Paulo and Boston Children's Hospital (BCH). The study was approved by the Minas Gerais Hospitalar Foundation Research Ethics Committee under number 094B/2017. It was also approved by the BCH Research Ethics Committee, number P00031402.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. No public data are available.

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