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Pediatric head and neck trauma in the United States: Trends, risk factors and outcomes using the National Trauma Data
Ashwini Sarathy1, Jamie Benson1, Kenny Nguyen1
1University of Vermont, Larner College of Medicine Burlington Vermont USA.
Insights
Pediatric head and neck trauma affects nearly half of young patients and is linked to higher mortality. Firearm exposure, young age, and lack of insurance significantly increase death risk in children with HN injuries.
Area of Science:
- Trauma Surgery
- Pediatric Emergency Medicine
- Public Health
Background:
- Pediatric head and neck (HN) trauma is a significant cause of morbidity with long-term consequences.
- Epidemiological predictors of pediatric HN trauma on a national scale are not well-established.
- Understanding risk factors is crucial for targeted prevention and intervention strategies.
Purpose of the Study:
- To identify independent risk factors for head and neck (HN) injury in the pediatric population.
- To determine predictors of mortality associated with pediatric HN trauma.
- To analyze national trends and outcomes of pediatric HN trauma.
Main Methods:
- Retrospective cohort study utilizing the US National Trauma Data Bank (NTDB) from 2007-2019.
- Analysis of demographic, injury, and physiological outcome data for patients under 18 years.
- Logistic regression was employed to identify independent predictors of mortality following HN trauma.
Main Results:
- Out of 1.42 million pediatric patients, 44.05% sustained HN injury.
- Falls were the primary mechanism in younger children (0-4 years), while motor vehicle accidents (MVTs) predominated in adolescents (14-17 years).
- HN injury independently increased mortality odds (OR 2.404). Firearm exposure, age <4, and self-insured status were strong predictors of mortality.
Conclusions:
- Pediatric HN trauma, while decreasing in prevalence, is associated with increased mortality.
- Age and insurance status are key predictors of mortality in pediatric HN trauma.
- Findings inform public health initiatives for injury prevention and management in children.
Introduction:
Pediatric head and neck (HN) trauma is an important contributor to pediatric morbidity, resulting in significant downstream consequences. Few studies provide epidemiological predictors of pediatric HN trauma on a national scale. The present study aims to identify risk factors of HN injury and mortality in the pediatric population.
Methods:
A retrospective cohort study was conducted for patients (age <18 years) using the US National Trauma Data Bank (NTDB 2007-2019). Demographic, injury, and physiologic outcome data were analyzed. HN injury was defined as a head or neck Abbreviated Injury Scale (AIS) >0. Logistic regression identified independent predictors of mortality following HN trauma.
Results:
Of the 1.42 million pediatric patients analyzed, 44.05% had HN injury. In patients aged 0-4, the most common mechanism was falls (47.67% in this age group) while in ages 14-17, motor vehicle/transport accidents (MVTs) were the most common mechanism (56.06%). Controlling for demographics, comorbidities, and injury severity, HN injury was associated with increased odds of mortality (OR 2.404, 95% CI 1.530-3.778). HN injury mortality was strongly predicted by firearm exposure (OR 11.28, 95% CI 6.074-20.95), age <4 (OR 1.179, 95% CI 1.071-1.299), and self-insured status (OR 1.977, 95% CI 1.811-2.157).
Conclusion:
NTDB data demonstrate that the percentage of pediatric patients with HN trauma has decreased over the past 12 years although is associated with increased odds of mortality. Age and insurance status predicted mortality from HN trauma, with falls and MVTs being the most common mechanisms of injury. These data have implications for future public health efforts in this patient population.
Level Of Evidence:
3.
