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In-hospital mortality pattern of severely injured children
Hien Quoc Do1, Jacob Steinmetz, Lars S Rasmussen
1Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. hien@dadlnet.dk
Insights
Severely injured children who died from trauma were younger and had higher injury severity scores. Most deaths occurred within 24 hours of admission, highlighting the critical nature of pediatric trauma care.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Injury Epidemiology
Background:
- Trauma is a significant cause of child morbidity and mortality, yet receives less research attention than adult trauma.
- Limited literature exists on pediatric trauma patterns and outcomes.
Purpose of the Study:
- To characterize the mortality patterns of severely injured children admitted to a Danish Level I trauma center.
- To identify predictors of in-hospital mortality in pediatric trauma patients.
Main Methods:
- Prospective data collection for pediatric trauma patients (≤15 years) over a 9-year period (1999-2007).
- Inclusion criteria: length of stay ≥ 72 hours, intensive care unit admission, or in-hospital death.
- Logistic regression analysis used to determine independent predictors of mortality.
Main Results:
- 331 pediatric trauma patients included; 92.7% survived.
- Younger age (median 5 years) and higher Injury Severity Score (ISS) (median 25) were associated with mortality.
- Two-thirds of deaths occurred within 24 hours of admission.
Conclusions:
- Younger age, higher injury severity, and early death are significant indicators for non-survival in pediatric trauma.
- These findings underscore the critical need for rapid and effective management of severely injured children.
Background:
Although trauma remains a major cause of morbidity and mortality in children, less attention has been directed to this group of patients. Whilst there is considerable literature on trauma in adults, only few studies describe paediatric trauma. The aim of this study was to describe the mortality pattern of severely injured children admitted to a Danish level I trauma centre.
Methods:
We included trauma patients aged 15 years or less, who subsequent a trauma team activation were admitted during the 9-year period 1999-2007. Data were collected prospectively for subjects who had a length of stay ≥ 72 h, were admitted to the intensive care unit (regardless of length of stay), or died in hospital. Logistic regression analysis was performed to assess independent predictors for in-hospital mortality. p<0.05 was considered statistically significant.
Results:
We included 331 patients, 199 (60.1%) boys/132 girls with a median age of 7 years and injury severity score (ISS) of 9. A total of 307/331 (92.7%) survived to discharge, and 16/24 (66.7%) deaths occurred within 24h after admission. Age was significantly lower in patients dying due to trauma (median 5 (0-15) vs. 7 (0-15) years, p=0.04, adjusted odds ratio (OR)=0.89 [95% CI: 0.80-0.99]). ISS was significantly higher in patients who died (median 25 (16-71) vs. 9 (4-29), p<0.0001, adjusted OR=1.15 [95% CI: 1.10-1.20]).
Conclusions:
Children who did not survive after severe trauma were significantly younger, more injured, and died early after admission.
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