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The injured child is resistant to multiple organ failure: a different inflammatory response?
Casey M Calkins1, Denis D Bensard, Ernest E Moore
1Department of Surgery, University of Colorado Health Sciences Center, Denver 80262, USA. casey.calkins@uchsc.edu
Insights
Pediatric postinjury multiple organ failure (MOF) is rare, occurring in only 3% of children. This study found pediatric MOF to be less severe than in adults, with lower mortality rates.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Immunology
Background:
- Multiple organ failure (MOF) is a known complication in adult trauma patients.
- The incidence and severity of postinjury MOF in pediatric populations remain largely uncharacterized.
- Existing research primarily focuses on adult MOF, leaving a gap in understanding pediatric outcomes.
Purpose of the Study:
- To determine the incidence, course, and severity of postinjury MOF in children.
- To compare pediatric postinjury MOF rates and outcomes with those observed in adult trauma patients.
- To test the hypothesis that pediatric MOF is less frequent and less severe than adult MOF.
Main Methods:
- Retrospective analysis of trauma registry data from pediatric and adult Level I trauma centers over three years.
- Inclusion criteria: trauma patients <16 years old, survival >24 hours, Injury Severity Score >15.
- Utilized an established MOF scoring system; statistical comparison using chi-squared and t-tests (p<0.05 significance).
Main Results:
- Of 534 eligible patients, 334 (head injury) were excluded, leaving 200 for analysis.
- The incidence of pediatric postinjury MOF was 3%.
- Mortality for pediatric MOF was 17%, significantly lower than historical adult data (50%).
Conclusions:
- Pediatric postinjury MOF occurs significantly less frequently than in adults, even with comparable injury severity.
- Postinjury MOF is a rare complication in children and presents with reduced severity.
- Investigating protective mechanisms in children could inform MOF prevention strategies across different age groups and diseases.
Background:
Although postinjury multiple organ failure (MOF) is a well-described phenomenon in adults, the incidence of this syndrome in children is unknown. The purpose of this study was to describe the incidence, course, and severity of pediatric postinjury MOF. We hypothesized that the incidence and severity of postinjury MOF in children would be less when compared with adults.
Methods:
Patients were retrospectively identified from the trauma registry of a regional pediatric trauma center and an adult Level I trauma center with pediatric commitment for a 3-year period. All trauma patients less than 16 years old who survived for longer than 24 hours and had an Injury Severity Score > 15 were eligible. An accepted MOF score was used. Categorical variables were compared by chi2 and continuous variables by t test. A value of p< 0.05 was considered statistically significant.
Results:
Of 534 patients identified, 334 (63%) were admitted for evaluation of isolated head injury and excluded from further analysis. The rate of postinjury MOF in children was found to be only 3%, with a low (17%) mortality when compared with historical adult data (50%).
Conclusion:
The incidence of postinjury MOF in the child is less than in the adult, given equivalent injury severity. These observations solidify the contention that postinjury MOF is rare in children, and is less severe when it occurs. Delineating the mechanism(s) whereby children are protected from postinjury MOF may provide insight into the development of strategies to prevent MOF in other age groups as well as various disease states.