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Functional status of pediatric patients with trauma and risk factors for mortality from a single center in China
Yu-Hang Yang1, Tie-Ning Zhang1, Ni Yang1
1Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
Insights
Pediatric trauma patients face a high mortality rate, with the Injury Severity Score (ISS) being a key predictor. Many survivors experience reduced functional status at discharge, particularly in motor and feeding abilities.
Area of Science:
- Pediatric Critical Care
- Trauma Surgery
- Rehabilitation Medicine
Background:
- Reduced functional status is increasingly relevant in trauma care due to declining mortality rates.
- Few studies have comprehensively assessed functional status in pediatric trauma patients at hospital discharge.
- Understanding risk factors for mortality and functional outcomes is crucial for improving care.
Purpose of the Study:
- To identify risk factors influencing mortality in pediatric trauma survivors.
- To analyze the functional status of pediatric trauma survivors at hospital discharge using the Functional Status Scale (FSS).
- To correlate injury severity with functional outcomes and mortality.
Main Methods:
- Retrospective analysis of pediatric intensive care unit patients meeting trauma criteria (January 2015 - January 2020).
- Recorded Functional Status Scale (FSS) and Injury Severity Score (ISS) upon admission and discharge.
- Utilized univariate and multivariate analyses to identify mortality risk factors.
Main Results:
- A total of 246 children were included; the hospital mortality rate was 15.9%.
- The Injury Severity Score (ISS) was identified as an independent risk factor for mortality.
- Nearly half of discharged survivors (48.3%) had mildly to very severely abnormal function, with motor and feeding domains most affected.
Conclusions:
- The mortality rate in pediatric trauma patients remains high.
- Injury Severity Score (ISS) is a significant independent predictor of mortality.
- A substantial proportion of pediatric trauma survivors experience persistent functional deficits at discharge, necessitating targeted rehabilitation strategies.
Introduction:
The influence of reduced functional status has become increasingly relevant because of the gradual decline in mortality rate over the recent years. Nonetheless, only a few studies investigating the functional status of patients with trauma at hospital discharge have been conducted. This study aimed to identify the risk factors influencing the mortality rate in pediatric trauma survivors at a pediatric intensive care unit and analyze their functional status using the Functional Status Scale (FSS).
Methods:
A retrospective analysis was conducted at Shengjing Hospital of China Medical University. Children admitted to the pediatric intensive care unit between January 2015 and January 2020 who met the trauma diagnostic criteria were included. The FSS score and the Injury Severity Score (ISS) were recorded upon admission and discharge, respectively. Clinical data were compared between the survival and non-survival groups to identify the risk factors for poor prognosis. The risk factors for mortality were identified using multivariate and univariate analyses.
Results:
A total of 246 children {59.8%, male; median [interquartile range (IQR)] age: 3 [1-7] years} were diagnosed with trauma (including head trauma, chest trauma, abdominal trauma, and extremity trauma). Of these patients, 207 were discharged, 11 dropped out mid-treatment, and 39 died (hospital mortality rate, 15.9%). Upon admission, the median FSS and trauma scores were 14 (IQR, 11-18) and 22 (IQR, 14-33) points, respectively. At discharge, the FSS score was 8 (IQR, 6-10) points. The patient clinical status improved with a ΔFSS score of -4 (IQR, -7, 0) points. At hospital discharge, 119 (48.3%), 47 (19.1%), 27 (11.0%), 12 (4.8%), and 2 (0.9%) survivors had good, mildly abnormal, moderately abnormal, severely abnormal, and very severely abnormal function, respectively. Reduced functional status in patients was categorized as follows: motor, 46.4%; feeding, 26.1%; sensory, 23.2%; mental, 18.4%; and communication, 17.9%. In the univariate analysis, ISS >25 points, shock, respiratory failure, and coma were independently associated with the mortality rate. Multivariate analysis revealed that the ISS was an independent risk factor for mortality.
Conclusion:
The mortality rate of patients with trauma was high. ISS was an independent risk factor for mortality. Mildly reduced functional status remained at discharge and was reported in nearly half of the discharged patients. Motor and feeding functions were the most severely impacted domains.
