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Impact of transportation methods on pediatric and adolescent severely injured vehicle occupants
Fikri M Abu-Zidan1,2, David O Alao3,4
1Trauma and Emergency Research Group, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain City, Abu Dhabi, United Arab Emirates. fmabuzidan@gmail.com.
Insights
Transportation by private vehicles is safe for injured children and adolescents following road traffic collisions (RTCs), showing no adverse effects on outcomes. Further research is needed on bystander roles in prehospital trauma care.
Area of Science:
- Trauma surgery
- Emergency medicine
- Public health
Background:
- Road traffic collisions (RTCs) represent a significant global health burden, particularly for pediatric and adolescent populations.
- Optimizing prehospital care, including transportation methods, is crucial for improving outcomes in severely injured individuals.
Purpose of the Study:
- To evaluate the impact of different transportation methods (ambulance vs. private vehicle) on severely injured pediatric and adolescent RTC victims in Abu Dhabi.
- To compare clinical outcomes, including intensive care unit (ICU) admission, hospital stay, and mortality, between the two transportation groups.
Main Methods:
- A prospective analysis of the Abu Dhabi Trauma Registry (January 2014-December 2023) identified severely injured (Injury Severity Score [ISS] ≥ 12) RTC patients (<19 years old).
- Data from patients transported by ambulance (n=466) were compared with those transported by private vehicles (n=47).
- Statistical analyses included univariate comparisons, logistic regression for ICU admission, and general linear models for hospital stay.
Main Results:
- Patients arriving by private vehicle were younger and had longer emergency department stays but were less likely to be admitted to the ICU and had shorter hospital stays.
- No significant difference in mortality rates was observed between the ambulance and private vehicle transport groups (2.1% vs. 6.7%, p=0.34).
- Mode of arrival did not significantly impact ICU admission or length of hospital stay; Glasgow Coma Scale (GCS) and ISS were key predictors for ICU admission, while GCS and Revised Trauma Score (RTS) influenced hospital stay.
Conclusions:
- Transportation of selected pediatric and adolescent major trauma patients via private vehicles appears safe, with no detrimental effects on ICU admission, hospital stay, or mortality.
- The findings suggest that private vehicle transport may be a viable option for specific cases, warranting further investigation into bystander roles in prehospital management.
Background:
Road traffic collisions (RTCs) are the leading cause of death globally. Reducing the transportation time to definitive care and training bystanders in trauma management may impact clinical outcome. We aimed to study the impact of transportation methods on pediatric and adolescent severely injured vehicle occupants in Abu Dhabi Emirate, United Arab Emirates.
Methods:
The Abu Dhabi Trauma Registry prospectively collects data of all hospitalized trauma patients from seven major trauma centers in Abu Dhabi Emirate. We have studied all severely injured (ISS ≥ 12) road traffic collision patients, who were less than 19 years old (January 2014 to December 2023). Demography and clinical outcome of those transported by ambulance (n = 466) were compared with those transported by private vehicles (n = 47).
Results:
Univariate analysis showed that patients who were transferred by private vehicles were significantly younger, (median (IQR range) age: 12 (6-15) years compared with 15.5 (12-17) years, p < 0.001), stayed significantly longer in the Emergency Department (median (IQR range) 275 (186-333) minutes compared with 214 (135-299) minutes, p = 0.01), were admitted significantly less to the ICU (31.9% compared with 51.9%, p = 0.009); and had significantly less hospital stay (median (IQR range) 3.5 (1-8) days compared with 7 (3-14) days, p = 0.003). There was no significant difference in mortality between the two groups (2.1% compared with 6.7%, p = 0.34). Logistic regression showed that mode of arrival did not significantly affect ICU admission (p = 0.26). The most significant factors that affected ICU admission were GCS, p < 0.001, OR 0.66 (95% CI 0.57-0.77) and ISS, p < 0.001, OR 1.12 (95% CI 1.08-1.16). A general linear model showed that GCS (p = 0.022) and RTS (p = 0.006) significantly affected length of hospital stay while mode of arrival did not (p = 0.38).
Conclusions:
Private vehicles appear to be safe for the transportation of selected major trauma children and adolescents with no adverse effects on ICU admission, hospital stay, or mortality. The role of bystanders in prehospital management and transportation of RTC victims should be further investigated.
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