Date Published: February 7, 2019
Publisher: Public Library of Science
Author(s): Mark G. Coulthard, Vanil Varghese, Lauren P. Harvey, Tona C. Gillen, Roy M. Kimble, Robert S. Ware, Richard Mink.
The aim of this study is to review patient characteristics, injury patterns, and outcomes of trauma cases admitted to pediatric intensive care in Children’s Health Queensland, Brisbane, Queensland, Australia.
Routinely recorded data collected prospectively from the Children’s Health Queensland Trauma Service registry from November 2008 to October 2015 were reviewed. Demographic and clinical characteristics of trauma cases in children under 16 years of age are described, and their association with age and mortality analyzed.
There were 542 cases of pediatric trauma identified and 66.4% were male. The overall mortality since January 2012 was 11.1%. The median injury severity score (ISS) was 11 (IQR = 9–22), 48.2% (n = 261) had an ISS > 12 and 41.7% (n = 226) patients had an ISS > 15. The most common injury patterns were isolated head injury (29.7%; n = 161) and multiple trauma (31.2%; n = 169). In 28.4% of cases (n = 154) surgery was required. The home was reported to be the most common place of injury (37.6%; n = 204). Children aged 0–4 years were least likely to survive their injury (15.3% mortality) compared with the 5–9 (5.6% mortality) and 10–15 (9.0% mortality) age groups. Higher mortality was associated with more severe injuries, abdomen/spine/thorax injuries, inflicted injuries, drowning and hanging.
This description of major pediatric trauma cases admitted to pediatric intensive care in Children’s Health Queensland, Australia, will inform future pediatric major trauma service requirements as it identifies injury patterns and profiles, injury severity, management and mortality across different age groups.
Trauma is a major public health problem worldwide across all age groups . In the developed world, pediatric trauma is the leading cause of death and disability in children and adolescents [2, 3]. Trauma in an infant, child or adolescent creates special considerations with specific injury patterns, diagnosis and management due to the age-dependent anatomy, physiology and cognitive variability in children . In the USA, it is estimated that one in four children will sustain an unintentional injury that requires medical care each year, and injury in children (aged 1–19 years) accounted for 34.4% of all childhood deaths in the USA in 2013 . The costs of pediatric trauma include both the initial hospitalization and ongoing financial burden due to disability and future work losses . Despite improvements in trauma care, a significant proportion of children live with long-term disability following major pediatric trauma .
This study provides a description of trauma cases admitted to the pediatric intensive care units in Brisbane, Queensland, Australia, between 2008 and 2015. The provision of pediatric severe trauma care within integrated trauma systems can be further improved by ongoing research to guide best practice . Collection of this data has the potential to inform critical care service resource management in Queensland and potentially improve patient outcomes. The data identifies high-risk injury patterns, profiles, severity, management and mortality in different age groups in pediatric major trauma. Higher mortality is associated with abdomen/spine/thorax injuries and with drowning and hanging as the mechanisms of inflicted injury. We identified a vulnerable young population in the 0–4 age group who had the greatest odds of mortality and represented a significant proportion of PICU admissions, with 28% of the overall cohort requiring an operative procedure. Unfortunately, the geographical location of the injury was not recorded in about two-thirds of the patients, so we cannot draw any conclusions about mortality outside the metropolitan area. This shortcoming is being addressed so that the trauma system across the large geographical state of Queensland can be analyzed and improved.
This study reports an overall mortality (since January 2012) of 11.1% for severe pediatric trauma with 28% overall requiring an operative procedure. Our study identifies a vulnerable young population in the 0–4 age group who have the greatest odds of mortality and represent a significant proportion of the children admitted to pediatric intensive care units following trauma