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Published on: September 21, 2017
Severe injury mechanisms in two paediatric trauma centres: Determination of prevention priorities
Claude Cyr1, Marianne Xhignesse, Jacques Lacroix
1Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke.
Insights
Identifying severe injury mechanisms in children is crucial for effective prevention programs. Falls from height and motor vehicle traffic injuries are leading causes, with priorities varying by severity measures and age groups.
Area of Science:
- Pediatric Trauma Research
- Injury Prevention Science
- Public Health
Background:
- Childhood injury prevention requires data-driven targeting of injury mechanisms.
- Understanding severe injury causes is essential for community needs.
- This study aimed to identify the most significant severe injury mechanisms in children.
Purpose of the Study:
- To identify the most important severe injury mechanisms in children.
- To inform the development of targeted injury prevention programs.
- To analyze variations in injury mechanisms by age and geographic center.
Main Methods:
- Retrospective review of severe pediatric trauma patients across two trauma centers.
- Calculation of injury prevention priority scores using multiple severity measures: Injury Severity Score (ISS), Revised Trauma Score, Trauma-Related Injury Severity Score, Glasgow Coma Scale (GCS), and mortality.
- Analysis of injury mechanisms, patient demographics, and use of safety devices.
Main Results:
- 3732 severe pediatric trauma cases identified; 66.2% were boys, mean age 9.0 years.
- Leading injury mechanisms included 'fall from height' (most frequent) and 'motor vehicle traffic injury' (most severe).
- Injury prevention priorities differed based on severity measures: ISS favored 'fall from height', mortality favored 'motor vehicle traffic injury', and GCS favored 'drowning/submersion'.
Conclusions:
- Severe injury prevention priorities in children are dependent on the chosen severity measures.
- Age-specific trends (falls in younger children, MVI in adolescents) and inter-center variations necessitate tailored prevention strategies.
- Failure to use safety devices was a common factor in severe pediatric injuries, highlighting the need for improved adherence.
Background:
To meet community needs, injury prevention programs for children should be targeted to trends in objective data on mechanisms of injury. The aim of the present study was to identify the most important severe injury mechanisms.
Methods:
The present study retrospectively reviewed severe paediatric trauma patients in two regional trauma centres. Injury prevention priority scores were computed using different severity measures - injury severity score (ISS), revised trauma score, trauma-related injury severity score, Glasgow Coma Scale (GCS) and mortality - to identify prevention priorities.
Results:
A total of 3732 children with severe injury were identified; mean age (+/-SD) was 9.0+/-5.2 years and 2469 (66.2%) were boys. The GCS was 7 or lower in 209 patients (5.6%) and the median ISS was 9. Overall, there were 77 deaths (2.1%). 'Fall from height' was the most frequent mechanism of injury, and 'motor vehicle traffic injury' resulted in the most severe injury. The most significant mechanisms of injury, using ISS, were 'fall from height', 'motor vehicle traffic injury', 'pedestrian struck by motor vehicle', 'bicycle injuries' and 'child abuse'. Different priorities were identified depending on the severity measures used - 'fall from height' would be the priority with ISS, revised trauma score and trauma-related injury severity score; 'motor vehicle traffic injury' with mortality and 'drowning/submersion' with GCS. 'Fall from height' was the highest ranked mechanism of injury in one centre compared with 'motor vehicle traffic injury' in the other. Younger children tended to have injuries as a result of falls, while adolescents had more motor vehicle occupant injuries. Failure to use safety devices, such as helmets and seat belts, was a common finding among severely injured children.
Conclusion:
The present study shows that the severe injury prevention priorities identified vary depending on the severity measures used. The variations seen across age groups and between the two centres are also important factors that must be taken into account when developing prevention programs or considering research initiatives.
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