Pediatric polytrauma at intensive care unit

Polytrauma and its consequences present a rising diagnostic and therapeutic problem we face at ICU every day. The goal of this research was to analyze and improve the diagnostic and treatment procedures.

A prospective research carried out at the multidisciplinary Intensive Care Unit during a period of over 2 years included 126 patients aged less than 15 years. Immediately on admission, all patients received the necessary care strictly complying with polytrauma treatment algorithms. We recorded the patients basic data (age, sex), cause of injury (fall, traffic accidents etc.) and injury type (blunt or penetrating) as well as the immediately performed procedures. The analysis of patients and calculation of mortality rates was based on time that had elapsed from injury to arrival at ICU, and severity of their injuries assessed as ISS score. Injury severity was assessed on admission also by using GCS, PTS, NISS and TRISS. Performed surgical interventions, mechanical ventilation duration, and total ICU time were recorded, as well as the need for transfer to a pediatric trauma centre.

96 patients arrived within 2 hrs from injury, with ISS>15, and/or PTS<8. 52 patients arrived within "golden hour"; 37 of them had ISS 16-26 and 15 had ISS>26 with mortality rate 3 (8%) vs 3 (20%) (p<0.001). Of the remaining 44 patients, 30 had ISS 16-26 and 14 had ISS>26, with mortality rate 7 (23.3%) vs. 5 (35.7%) (p<0.001).

The arrival at ICU during "golden hour", precise algorithms, high quality of diagnosis, monitoring and therapeutic procedures had an essential influence on the positive end-outcome and improved the survival and recovery rates in polytraumatized children (Tab. 4, Fig. 1, Ref. 18). Full Text (Free, PDF) www.bmj.sk.