PENTA Registratie en evaluatie van de omstandigheden en modaliteiten van trauma en trauma zorg voor kinderen en jongeren in Vlaanderen To our opinion, physicians involved in trauma care have an equal responsibility towards injury prevention and surveillance, towards research and education, quality assurance and policy making. Within this vision we set up the PENTA project

DOELSTELLINGEN... Epidemiologische “populatie-wijde” data over ongevallen bij kinderen en jongeren in Vlaanderen Het beschrijven vd. lange termijn gevolgen Een evaluatie vd. verleende medische zorg Data collectie is een middel, geen doel! From the beginning, PENTA was conceived as an open research project, driven by aims rather than hypotheses Up-to-date, high quality ... Epidemiological data are the basis of any further intervention and therefore indispensable. International data are insufficient in describing the local situation. Current available data for Flanders appear fragmentary, methodologically flawed and out-of-data . Importantly... Injury surveillance is more than registration; it’s about translating information into actionthe definite goal should be quality improvement

Deelnemende centra: ASZ Aalst St. Blasius Dendermonde UZ Gent AZ MMSJ Gent Jan Palfijn ZH Gent AZ St. Lucas Gent AZ Oudenaarde AZ MM St. Niklaas AZ Groeninge Kortrijk HH ZH Menen HH ZH Roeselare AZ St. Maarten Mechelen AZ St. Maarten Duffel St. Vincentius ZH Antwerpen Klina Brasschaat AZ Stuivenberg Antwerpen ZH Noord-Limburg Lommel ZOL Genk UZ Gasthuisberg Leuven

Populatie – wijd... Some might argue that injury surveillance should be population-based by definition; anyhow the added value of having population data is significant. the 18 hospitals eventually included (1 dropped because of insufficient data) were equally spread for location as for hospital characteristics, and covered about ¼ of the Flemish community (in number of accredited ED 18/70 and consulting patients i.e. approximately 390000/y). Although not completely random, we consider this sample large and well-selected enough to be representative. Verhoudingsgewijs we lmeer grotere ziekenhuizen (> 500beds), waardoor sample wat betreft B populatie vermoedelijk meer da n25%

The burden of injury (1) Benaderde jaarlijkse incidentie Vlaanderen: 119/1000/y ~ 1/10 Spoed consultaties en 50% pediatrische consultaties Meest frequente diagnostische codes (% totaal): Flanders 1.2 milj inwoners >18y FOR CHILDREN VISITING ED WITH INJURY G.P. NOT included: up to 30 - 50% of all medical treated injured

The burden of injury (2) 13.5% consult na doorverwijzing moment van consultatie: 22-6h: 5.3% 16-21h: 48.9% Moment ongeval: mediaan 15h; 32.8% Zat. / Zo. 59.1% jongens mean 9.5 j (SD 5.3j) 23.9% < 5j, 21.9% > 14j geslachtsverschillen >> speelplaats/sportterrein ongevallen (p<0.0001) << bv. traumatic brain injury ONLY (6.2% after an EMS intervention) Referral no difference in age (p=0.24) or gender (p=0.76), less likely during the night (p=0.0005) Differences in age and gender are not unexpected as they represent what children of different ages respectively do and where they spent most of their time Moment of accident: all through the day,

Leeftijd en geslachtsspecifiek 1 accident circumstances / 2 accident location Letsels en omstandigheden gekoppeld aan locatie....

The burden of injury (3) ZH opname: 7.1%; ~ ¾ < 48u 38.4% fracturen; 37.7% TBI “Ernstig” trauma: ~1% ~ 50% VKO 53% prehospitaal interventie ~1/2 IZ opname Hospitaal LOS mediaan 6d (IQR 10) 6.1% mortaliteit (60% verkeer, 13% suicide; 1/3 on scene) Overlevenden: 10.5% matig / ernstige handicap Admission overall younger except if severe injury; more often vehicle related Severe defined as hospital admission longer than 48u if not ... OVERALL CASE FATILITY RATIO FOR PEDIATRIC TRAUMA 1/2400

“Closing the gap” EEN AUDIT VAN HET MEDISCH BELEID BIJ ERNSTIG PEDIATRISCH TRAUMA IN VLAANDEREN more and more variability in care reported, care delivered seems often inconsistent with current evidence... Variability means optimal care not well-defined (opportunity for research) or not adhered to (opportunity for improvement) Doing things right form the start has been shown to have significant impact on survival and morbidity Closing the knowledge-performance gap is considered one of the most important challenges for the medical profession... Audit identifies sticking points and barriers, flaws and needs; is incentive for change, by identifying flaws and needs ( + Hawthorne effect..)

Ernstig pediatrisch trauma is zeldzaam... Medical caregivers more at risk of being unprepared when treating severely injured children

ICF-related outcome scoring [IROS]: Ontwikkeling van een instrument om de outcome bij kinderen en jongeren te meten (na een ongeval of ernstige ziekte)

Conclusies PENTA verschaft voor de eerste maal populatie-wijde data over trauma bij kinderen/jongeren voor Vlaanderen Bruikbaar: verder onderzoek, preventie, beleid, audit... nood aan continue trauma surveillance PENTA benadrukt “the global burden” van ‘pediatrisch’ trauma in Vlaanderen (~ 119/1000/j) >> zonder doorverwijzing + mineure letsels Kleine subgroep ernstige letsels & risico op lange-termijn problemen, overlijden (~ 170 jaarlijks) 119/1000/y ED consults (+ ~30% via HA...); approx 1% severe; case fatality 1/2400

Conclusies PENTA identificeerde suboptimale zorg PENTA... Meer Simulatie PENTA detecteerde dat, zelfs na 1 jaar, het impact op de (biopsychosociale) gezondheid van patient en zijn/haar familie vaak belangrijk is PENTA... Project trajectbegeleiding