Pediatric blunt and penetrating trauma deaths in Ontario: a population-based study
Ivan R Diamond1, Patricia C Parkin, Paul W Wales
1The Hospital for Sick Children, Toronto, Canada.
Insights
Most pediatric trauma deaths in Ontario occur at the scene, primarily from severe head injuries. Prevention strategies are crucial to reduce child mortality in modern trauma systems.
Area of Science:
- Pediatric Trauma Care
- Injury Epidemiology
- Public Health
Background:
- Understanding pediatric injury deaths is vital for improving trauma system effectiveness.
- Modern trauma systems aim to reduce mortality through integrated care and rapid response.
Purpose of the Study:
- To investigate the mechanisms of injury and causes of death in children within a contemporary trauma system.
- To analyze pediatric trauma mortality data to inform prevention strategies.
Main Methods:
- Retrospective analysis of records for children (<16 years) who died from trauma in Ontario (2001-2003).
- Data collection included demographics, injury nature, causes of death, and survival duration.
- Mortality rates were calculated using census data.
Main Results:
- 234 pediatric injury deaths occurred (222 blunt, 12 penetrating), with 13% intentional.
- Motor vehicle incidents accounted for 68% of deaths; 74% died at the scene.
- Severe craniocervical injuries (AIS 5-6) were present in 84% of fatalities.
Conclusions:
- Severe head injuries are the leading cause of pediatric trauma deaths, often occurring pre-hospital.
- Effective strategies must prioritize primary and secondary injury prevention to decrease pediatric mortality.
Purpose:
The purpose of the study was to describe the mechanisms of injury and causes of death in children dying in a modern, integrated trauma system.
Method:
Records of all children (<16 years of age) who died in Ontario from 2001 through 2003 after blunt or penetrating trauma were obtained from the Chief Coroner. Demographics and the nature and causes of injury and the causes of death were recorded. Estimates of the mortality rate were determined using census data.
Results:
There were 234 injury deaths (222 blunt, 12 penetrating) over the 3 years. Thirty (13%) resulted from intentional injury. The median age was 10 (range, 0-15.9) years; 62% were male. Sixty-eight percent resulted from incidents involving motor vehicles (passenger, pedestrian, or cyclist). Most (74%) died at the scene; only 5% survived for more than 24 hours. Devastating craniocervical injury (Abbreviated Injury Scale 5 or 6) was present in 84% and was the only life-threatening injury in 40%. The annual mortality rate averaged 3.2 per 100,000 children.
Conclusions:
In a modern, integrated trauma system, most pediatric injury deaths occur at the scene from severe head injuries. In this population, strategies to reduce the death rate from pediatric trauma must focus on primary and secondary injury prevention.
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