Preventable pediatric trauma deaths in a metropolitan region
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E H Dykes1, L J Spence, J G Young
1Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Pediatric trauma deaths in Toronto revealed that 13% of child fatalities were preventable. Objective criteria identified survivable injuries, suggesting a lower preventable death rate than in adults.
Area of Science:
- Traumatology
- Pediatric Emergency Medicine
- Public Health
Background:
- Pediatric trauma remains a significant cause of mortality in children.
- Accurate assessment of injury severity is crucial for determining preventability.
- Previous studies on preventable death rates (PDR) in pediatric trauma are limited.
Purpose of the Study:
- To analyze pediatric trauma deaths in metropolitan Toronto using objective injury severity criteria.
- To estimate the preventable death rate (PDR) in pediatric trauma cases.
- To compare the PDR in pediatric trauma with that of adult trauma victims.
Main Methods:
- Retrospective analysis of all pediatric trauma deaths in Toronto in 1986 using coroner's records.
- Injury scoring using the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS).
- Definition of 'unsalvageable' injuries based on AIS 6, AIS 5 head/neck, or ISS > 59.
Main Results:
- Out of 38 pediatric trauma deaths, 8 (21%) had injuries deemed survivable using objective criteria.
- Considering social circumstances where medical aid was not sought, the estimated preventable death rate (PDR) was 5/38 (13%).
- The identified PDR in pediatric trauma may be lower than previously reported for adult trauma victims.
Conclusions:
- Objective criteria can effectively identify survivable injuries in pediatric trauma.
- A realistic estimate of preventable death rate in pediatric trauma is approximately 13%.
- Defining PDR with objective criteria facilitates comparative studies and enhances understanding of pediatric trauma outcomes.
Abstract:
All pediatric trauma deaths occurring in metropolitan Toronto (population, 2.2 million) in 1986 were analyzed from the regional coroner's records. Injuries sustained were scored using the Abbreviated Injury Scale (1985; AIS) and Injury Severity Score (ISS). Victims with injuries graded AIS 6 (any region), AIS 5 head/neck (excluding acute epidural hematoma), or ISS greater than 59 were deemed unsalvageable. All other injuries were considered survivable and the deaths from them preventable. Use of these objective criteria indicated that 8/38 of the children (21%) who died from trauma had survivable injuries. Since in three cases medical aid was not sought because of social circumstances, 5/38 (13%) was considered a realistic estimate of preventable death rate (PDR). These results suggest that when objective criteria are used, the PDR in pediatric trauma may be less than that reported in adult trauma victims. Defining the PDR on the basis of objective criteria may prove useful in the conduct of further studies of this kind and permit valid comparisons to be made.