Emergency trauma surgery outcomes are worse for children in low-income countries.

Children who require life-saving emergency surgery after a serious injury are almost six times more likely to die in poor countries than in rich countries, according to an international study led by the University of Cambridge.

Research, published in Lancet Child and Adolescent HealthAn analysis of 237 children aged 18 and younger who had trauma laparotomy – emergency surgery for severe abdominal injuries – in 85 hospitals in 32 countries was analyzed. It is one of the largest international studies to date to investigate this type of emergency surgery in children.

Traumatic injuries, including road traffic accidents and violence, are among the leading causes of death and disability in children and adolescents worldwide. The study looked at children who required emergency surgery for severe abdominal injuries, comparing their care and outcomes in hospitals around the world.

Big difference in care and outcomes

Overall, 8% of the children in the study died within 30 days of surgery. After taking into account differences between patients and settings, children treated in countries with lower levels of development were about six times more likely to die than children treated in countries with higher levels of development.

The study found large differences in the care children received, which may be important in understanding why outcomes were worse in poorer countries. Children often face longer delays in reaching hospital and undergoing surgery. They were also less likely to receive a blood transfusion, have a CT scan, receive a medicine used to reduce bleeding or be operated on by a consultant surgeon.

The share of children in these cases is also higher in poor countries than in rich countries. This suggests that poor countries may face a dual challenge: more children needing emergency surgery after a stroke, and less access to the care they need to treat them.

Children who require emergency surgery after a stroke are far more likely to die in less developed countries. “This reflects the challenges faced in trauma, ranging from delays in care to blood transfusions and limited access to intensive care.”

Timothy Hardcastle, co-author, Professor, University of KwaZulu-Natal, South Africa

These findings also point to a broader issue: Many trauma systems are designed around adults, even though children have different clinical needs.

“Children are not just little adults,” said co-lead author Dr. Michael Bath of the University of Cambridge. “They need different equipment, different expertise and rapid access to specialist care. Our findings show that, in many parts of the world, trauma systems are not yet set up to meet children’s needs.

“There is no single solution, but improving survival will require trauma care focused on children – from the moment of injury through transport to hospital, emergency surgery, intensive care and recovery.”

Designing trauma care around children

Adult trauma systems cannot be easily copied for children. Children’s physical needs, injury patterns, and recovery needs are different, meaning that best practice trauma care for adults may not always translate into the best care for injured children.

The researchers call on governments, health ministries and international organizations to prioritize child-specific trauma care. This includes age-specific equipment, referral pathways designed for children, staff training, and improved access to blood transfusions, CT imaging, organ support, senior clinical care, and rehabilitation. Strengthening these systems can help reduce avoidable deaths and improve the recovery of injured children around the world.