Hospital choice key to kids' survival

On average, children who were sent to Middlemore first did not get to Starship until eight hours after their accident. Photo / Thinkstock

Where ambulances take badly injured children first seems to affect their chances, paediatric surgeons say.

Starship children's hospital surgeons have found that sending badly injured children to the wrong hospital may be contributing to a child death rate from injuries that is twice the rate of Australia's.

Their study, due to be presented to an Australasian surgeons' conference in Auckland today, has found that 88 out of 100 children with severe injuries in South Auckland in the five years to August 2011 went to Middlemore Hospital before transferring to Starship, which has the region's only specialist paediatric surgeons and neurosurgeons.

On average, children who were sent to Middlemore first did not get to Starship until eight hours after their accident, compared with two and a half hours for those who went directly to Starship.

The authors, paediatric surgeons Dr Clara Chong and James Hamill, said Auckland was in desperate need of a "structured trauma system", including guidelines for ambulance drivers to take the most severely injured children straight to Starship.

Statistics NZ figures show that an average of 98 children died from injuries every year in New Zealand in the decade to 2010, or 11.1 deaths for every 100,000 children aged under 15. There was only a slight downward trend from a death rate of 11.2 a year in the first half of the decade to 10.7 in the second half.

In contrast, only 5.5 children in every 100,000 died from injuries in Australia in 2005. Otago University research shows car accidents are the leading cause of fatal injuries for those aged 5 to 19, accounting for 31.5 per cent of fatal injuries for children aged 5 to 9, 18 per cent for those aged 10 to 14 and 42.2 per cent of those aged 15 to 19.

Mr Hamill said most of the severe injuries in the Starship study were due to car accidents, with children as passengers in cars or pedestrians.

Head injuries accounted for 81 per cent of those who went first to Middlemore and 67 per cent of those who went direct to Starship.

Most of those sent first to Middlemore were Maori (39 per cent) or Pacific Islanders (36 per cent), with only 16 per cent European.

But European children accounted for six of the 12 children sent directly to Starship. Only three of that group were Maori and two Pacific.

Just over half of those sent to Middlemore were taken by ambulance (51 per cent), with 39 per cent arriving by private vehicle.

Three of the 12 who went directly to Starship went by ambulance, with three by helicopter and five in cars.

Mr Hamill said ambulance drivers did not have a protocol in place for severely injured children, but did "an excellent job" in following protocols where they did exist, such as taking burns patients from all over Auckland to Middlemore's national burns unit.

"Their protocol [in South Auckland] says go to Middlemore. The helicopter people are a lot more free to pick and choose their hospital."

The study did not find any difference in death rates in the two groups. Six (7 per cent) of the 88 children who went first to Middlemore died, but so did one (8 per cent) of the 12 who went directly to Starship.

"The figures are so small that it's hard to perceive a difference," he said.

He said overseas research showed that a good trauma protocol system could cut the death rate for injured adults by 20 to 30 per cent, but there was no good data for children.

The head of Starship's emergency department, Dr Mike Shepherd, said the major factors contributing to New Zealand's high fatal injury rate for children lay outside the hospital system in policies such as driver blood-alcohol limits, graduated driver licensing, and laws requiring children's booster seats and swimming pool fences.

St John clinical direction Dr Tony Smith said the organisation supported taking patients directly to the hospital of definitive care whenever feasible because "there is evidence that this improves outcomes".

"There is an existing policy in place for patients with major trauma. It directs that patients be taken to Middlemore Hospital, Auckland City Hospital, or Starship Hospital, whichever is the closest. This policy was developed in consensus with DHB clinical personnel and St John clinical personnel. The policy is due for review this year."