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Urban trauma: an analysis of 1,116 paediatric cases
B S Chan1, P J Walker, D T Cass
1Paediatric Surgical Unit, Westmead Hospital, Sydney, Australia.
Insights
Most pediatric trauma cases involve falls and minor injuries. However, serious injuries, often from motor vehicle accidents, require immediate attention, with head injuries being critical. Trauma Score shows promise in predicting severe outcomes.
Area of Science:
- Pediatric Trauma Research
- Injury Epidemiology
- Emergency Medicine
Background:
- Pediatric trauma is a significant cause of morbidity and mortality in children.
- Understanding injury patterns and predictive factors is crucial for effective management.
- Previous studies highlight the need for accurate assessment tools in pediatric trauma.
Purpose of the Study:
- To analyze the nature of injuries in children admitted to an urban teaching hospital.
- To identify factors predicting serious injury and mortality in pediatric trauma patients.
- To evaluate the predictive value of the Trauma Score and Method of Injury for serious outcomes.
Main Methods:
- Prospective study of 1,116 children admitted over a 2-year period.
- Analysis of injury types, causes, and outcomes.
- Evaluation of the Trauma Score and Method of Injury against the Injury Severity Score.
Main Results:
- Most injuries were minor, often falls affecting the upper limb (57%).
- Serious injuries occurred in 13% of cases, frequently head injuries in pedestrians (31%).
- All 16 deaths were linked to motor vehicle accidents and severe head trauma; Trauma Score <= 12 predicted all deaths.
Conclusions:
- Falls are the most common cause of pediatric injury, but motor vehicle accidents lead to severe outcomes.
- The Trauma Score demonstrates high specificity (99%) and positive predictive value (86%) for severe injury.
- Helmet use in cyclists (9%) and restraint use in car occupants (39%) were notably low, indicating potential for prevention.
Abstract:
Over a 2-year period 1,116 children admitted to an urban teaching hospital were studied prospectively. The overall group was analysed as to the nature of the injury and a subgroup of seriously injured children was identified and further analysed. All deaths were examined as to their cause and possible preventable as well as salvageable factors. The predictive value of the Trauma Score (T.S.) and Method of Injury (M.O.I.) were evaluated for their prospective prediction of serious injury as determined by the Injury Severity Score and outcome. Most of the children were not seriously injured, with the most common injury being due to a fall (57%) and involving a single injury to the upper limb. With the subgroup of 143 children (13% of the total) who suffered serious injuries, the cranial cavity (90%) was the most common site of injury, occurring most often in pedestrians (31% of the total injured). There were 16 deaths in the series, representing 1.4% of all paediatric trauma admissions and 11% of the admissions who were seriously injured. All deaths were related to motor vehicle accidents and associated with serious head injury. A Trauma Score less than or equal to 12 accurately included all deaths but when correlated with the I.S.S., the Trauma Score had a specificity of 99% and a positive predictive value of 86%; its sensitivity was only 27%. The Method of Injury was associated with an overtriage rate of 300% in relation to the I.S.S.. Of children admitted following pedal cycle accidents only 9% were wearing helmets. Of car occupants injured, 39% were unrestrained.(ABSTRACT TRUNCATED AT 250 WORDS)