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Epidemiologic aspects of pediatric multiple trauma in a Spanish urban population
D Sala1, E Fernández, A Morant
1Department of Surgery, Valencia University Medical School, Spain.
Insights
Pedestrian accidents are the leading cause of pediatric multiple trauma (MT), often resulting in head injuries and prolonged hospital stays. Prevention efforts should focus on children aged 6-10, as the modified injury severity score (MISS) predicts outcomes.
Area of Science:
- Pediatric Traumatology
- Epidemiology
- Injury Prevention
Background:
- Multiple trauma (MT) is a significant cause of mortality and disability in children and adolescents.
- This study investigated the epidemiology of pediatric MT in a Spanish urban university hospital.
Purpose of the Study:
- To analyze the causes, characteristics, and outcomes of pediatric multiple trauma.
- To evaluate the utility of the modified injury severity score (MISS) in predicting outcomes for pediatric MT patients.
Main Methods:
- A prospective epidemiologic study was conducted over 6 years, including 56 pediatric patients with MT.
- MT was defined by specific fracture criteria or combined injuries across multiple regions.
- The modified injury severity score (MISS) was used to assess injury severity.
Main Results:
- Pedestrian injuries accounted for 54% of MT cases.
- The overall mortality rate was 11.5%, with head trauma being the most frequent associated injury and cause of death.
- A higher MISS (above 18) correlated with significantly longer hospitalization periods.
Conclusions:
- Motor vehicle-related pedestrian accidents are a primary cause of pediatric MT in urban settings.
- Targeted prevention strategies for children aged 6-10 are recommended.
- The MISS is a valuable tool for predicting survival and hospital stay duration in pediatric MT.
Background/Purpose:
Trauma is still the most frequent cause of mortality and disability in childhood and adolescence. An epidemiologic prospective study on children under 16 years of age with multiple trauma (MT) was conducted in a large Spanish urban university hospital over a 6-year period.
Methods:
Of 1,937 children admitted at the pediatric trauma unit for musculoskeletal injuries from March 1988 until March 1994, 56 patients including 37 boys and 19 girls had MT. MT was considered when at least 2 long bones were fractured or there was a fracture of 1 long bone combined with an injury of 4 other major anatomic regions (face and neck, thorax, abdomen, or neural system). The severity of injuries was evaluated according to the modified injury severity score (MISS).
Results:
Injury to pedestrians was the most frequent cause of MT (54%). The overall mortality rate of the series, including those children dying during transport to the hospital was 11.5%. The average MISS for the whole group was 15 (range, 5 to 59). Head trauma was the most frequent associated injury (52%), two thirds of which were considered minor injuries (Glasgow Coma Scale >15). Seventy-seven fractures were registered, 10% of which were open fractures. External fixation was the most common surgical technique among operated fractures. The average hospitalization period was 16 (median, 13; range, 1 to 150) days. Children with a MISS above 18 points showed a significant longer hospitalization period (mean, 31 +/- 45 days) as compared with those with MISS below 18 points (mean, 10 +/- 7 days; P < .05). There was a strong correlation between the MISS and both the period of hospitalization at the pediatric intensive care unit and the total length of hospital stay.
Conclusions:
Pedestrian accidents caused by motor vehicles in children playing at the street contributed most significantly to MT in the urban pediatric population. Special care for prevention must be taken in the age group of 6 to 10 years. Head injury was the main cause of death in children with multiple trauma. MISS was found to be a good predictor of survival and duration of hospital stay in pediatric MT.