Abstract

Pediatric trauma is a leading cause of emergency department (ED) visits and mortality. Contemporary care shows rapid triage, pediatric-ready ED systems, and judicious imaging to reduce ionizing radiation exposure while maintaining diagnostic accuracy. This study aimed to synthesize original evidence on patterns, interventions, and outcomes in pediatric ED trauma care, focusing on prehospital time, ED pediatric readiness, and imaging strategies. A systematic review was performed of ten original studies and complemented the interpretation with eight contextual studies for the discussion. Outcomes included mortality, complications, ED/hospital utilization, and test accuracy. In multicenter cohorts, higher ED pediatric readiness was associated with lower mortality (adjusted odds ratios = 0.58-0.65) and potentially large numbers of lives saved system-wide. Prehospital analyses suggested a non-linear relation between time and mortality, with the lowest risk around 45-60 minutes. Among admitted children, self-transport was common and linked to under-activation of trauma teams and longer ED stay. Imaging work showed Pediatric Emergency Care Applied Research Network rules maintain good negative predictive value (NPV) for clinically important traumatic brain injury and intra-abdominal injury, whole body computed tomography (CT) (WBCT) confers no mortality benefit versus selective CT, and Focused Assessment with Sonography for Trauma offers moderate sensitivity but high NPV when negative. Strengthening ED pediatric readiness, optimizing activation for self-transport arrivals, aiming for efficient (

Key words: Pediatric trauma, emergency department, prehospital time, PECARN, systematic review