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[Children and accidents: decreasing mortality, different care].

In order to explore the demand for trauma care facilities for children with severe injuries in the University Hospital of Rotterdam, the departments of Paediatric Surgery and Epidemiology initiated a study of mortality, morbidity and patterns of trauma care. The standardized mortality rate in the region declined by 40% between 1979 and 1986, as did the clinical prevalence of trauma injuries, expressed by the number of days spent in hospital per 100,000 children. This was in agreement with the national epidemiological data. The number of hospital admissions for childhood injuries in the University Hospital of Rotterdam stabilized in recent years, which may be considered a relative increase. Moreover the number of children with severe injuries admitted to Intensive Care Units increased by 46%, which was mainly due to Intensive Care admissions of children living outside Rotterdam. Obviously, another pattern of referral of these patients has developed in the south-west of The Netherlands. The decrease of the number of severe injuries in childhood together with the complexity of trauma care and the increasing number of physicians raises questions on the maintenance of skills. This is an argument for centralization of trauma care for severely injured children, which to some extent has already been implemented in this region.