Children who need life‑saving emergency surgery after a serious injury are almost six times more likely to die if in poorer countries than in wealthier ones, according to an international study led by the University of Cambridge.
The research, published in The Lancet Child & Adolescent Health, analysed 237 children aged 18 and under who underwent trauma laparotomy – emergency surgery for severe abdominal injuries – in 85 hospitals across 32 countries. This is one of the largest international studies to date to examine this type of emergency surgery in children.
Traumatic injuries, including those caused by road traffic accidents and violence, are among the leading causes of death and disability in children and adolescents worldwide. This study looked at children who needed emergency surgery for severe abdominal injuries, comparing their care and outcomes across hospitals around the world.
Overall, 8% of children in the study died within 30 days of surgery. After taking account of differences between patients and settings, children treated in countries with lower levels of development were almost six times more likely to die than those treated in countries with higher levels of development.
The study found major differences in the care children received, which are likely to be important in understanding why outcomes were worse in poorer countries. Children often faced longer delays before reaching hospital and before receiving surgery. They were also less likely to receive a blood transfusion, have a CT scan, receive medicine used to reduce bleeding, or be operated on by a consultant surgeon.
Children also made up a larger share of these cases in poorer countries than in wealthier ones. This suggests that poorer countries may face a double challenge: more children needing emergency surgery after trauma, and less access to the care needed to treat them.
“Children who need emergency surgery after trauma are far more likely to die in less developed countries," said co-author Professor Timothy Hardcastle from the University of KwaZulu-Natal in South Africa. "This reflects challenges across the trauma pathway, from delays in reaching care to limited access to blood transfusion and intensive care.”
These findings also point to a wider issue: many trauma systems have been designed around adults, even though children have different clinical needs.
“Children are not just small adults," said senior author Dr Michael Bath from Cambridge's Department of Engineering. "They need different equipment, different expertise and fast 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 fix, but improving survival will require trauma care to be designed with children in mind — from the moment an injury happens, through transport to hospital, emergency surgery, intensive care and recovery.”
Adult trauma systems cannot simply be copied across to children. Children have different physical needs, injury patterns and recovery needs, meaning that best-practice trauma care for adults may not always translate into the best care for injured children.
The authors call for governments, health ministries and international organisations to prioritise child-specific trauma care. This includes age-specific equipment, referral pathways designed for children, staff training, and better access to blood transfusion, CT imaging, organ support, senior clinical care and rehabilitation. Strengthening these systems could help reduce avoidable deaths and improve recovery for injured children worldwide.
Riaz Aziz, Michael F. Bath et al. 'Understanding Paediatric Trauma Laparotomy Pathways Worldwide: Analysis of a Global Dataset.' The Lancet Child & Adolescent Health (2026). DOI: 10.1016/S2352-4642(26)00069-6
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