Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members
Authors: Reichert Martin , Sartelli Massimo , Askevold Ingolf H. , Braun Jaqueline , Weigand Markus A. , Hecker Matthias , Agnoletti Vanni , Coccolini Federico , Catena Fausto , Padberg Winfried , Riedel Jens G. , Hecker Andreas ,   The WSES pediatric emergency surgery collaboration group, Dogjani Agron , Kuriyama Akira , Porcu Alberto , Martínez-Pérez Aleix , Coppola Alessandro , Spolini Alessandro , Giordano Alessio , Kyriakidis Alexandros , Mohamedahmed Ali Yasen Y. , Vasilopoulou Anastasia , Zakaria Andee Dzulkarnaen , Balla Andrea , Fette Andreas , Litvin Andrey , Guariniello Anna , Isik Arda , Kechagias Aristotelis , Mitul Ashrarur Rahman , De Simone Belinda , Zampogna Biagio , Sensi Bruno , Gazia Carlo , Seretis Charalampos , Brooke Cristine , Luppi Davide , Coletta Diego , Sasia Diego , Corallino Diletta , Chatzipetris Dimitrios , Schizas Dimitrios , Lostoridis Eftychios , Hsabo Elmuiz A. , Kaouras Emmanouil , Schneck Emmanuel , Pinotti Enrico , Dimitrov Evgeni , D’Acapito Fabrizio , Saraceno Federica , Abu-Zidan Fikri , Silvestri Francesca Maria , Favi Francesco , Fleres Francesco , Mulita Francesk , Nita Gabriela , Martines Gennaro , Mazzarella Gennaro , Perrone Gennaro , Giraudo Giorgio , Bacchiocchi Giulia , Argenio Giulio , Brisinda Giuseppe , Currò Giuseppe , Palomba Giuseppe , Fraga Gustavo P. , Hamid Hytham K. S. , Katsaros Ioannis , Negoi Ionut , Tochie Joel Noutakdie , Davies Justin , Kok Kenneth Y. Y. , Apostolou Konstantinos G. , Lasithiotakis Konstantinos , Tsekouras Konstantinos , Sydorchuk Larysa , Siragusa Leandro , Solaini Leonardo , Ferrario Luca , Buonomo Luis , Walędziak Maciej , Gachabayov Mahir , Bulanauca Maloni , Agrawal Manish Kumar , Ceresoli Marco , Ranucci Maria Chiara , Petridou Maria , D’Oria Mario , Veroux Massimiliano , Frountzas Maximos , Teuben Michel Paul Johan , Bala Miklosh , Minger Mirja Amadea , Gonçalves Miroslava , Sharma Natasha , Tamini Nicolò , Medappil Noushif , Ioannidis Orestis , Bisagni Pietro , Rahim Razrim , Gonsaga Ricardo Alessandro Teixeira , Ragozzino Roberta , Bini Roberto , Cammarata Roberto , Sydorchuk Ruslan , Di Saverio Salomone , Awad Selmy S. , Atici Semra Demirli , Meric Serhat , Chowdhury Sharfuddin , Xenaki Sofia , Pintar Tadeja , Perra Teresa , Hardcastle Timothy C. , Voglino Valerio , Lohsiriwat Varut , Kong Victor , Christos Voskidis , Zuidema Wietse 
Published: January 2023

Abstract
Background
In contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world.

Methods
A web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021–03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients´ age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis.

Results
A total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (> 500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children ≤ 10 and ≤ 5 years of age (p = 0.0014). This situation is aggravated in participants from smaller hospitals (p < 0.01). With regard to hospital size (≤ 500 versus > 500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p < 0.0001), treated children at all ages more frequently (p = 0.0938) and have higher case-loads of severely injured children < 12 years of age (p = 0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p < 0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively).

Conclusions
Multi-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management.