Causes of early mortality in pediatric trauma patients

Abstract

BACKGROUND Trauma is the leading cause of death in children, and most deaths occur within 24 hours of injury. A better understanding of the causes of death in the immediate period of hospital care is needed. METHODS Trauma admissions younger than 18 years from 2009 to 2019 at a Level I pediatric trauma center were reviewed for deaths (n = 7,145). Patients were stratified into ages 0–6, 7–12, and 13–17 years old. The primary outcome was cause of death, with early death defined as less than 24 hours after trauma center arrival. RESULTS There were 134 (2%) deaths with a median age of 7 years. The median time from arrival to death was 14.4 hours (interquartile range, 0.5–87.8 hours). Half (54%) occurred within 24 hours. However, most patients who survived initial resuscitation in the emergency department died longer than 24 hours after arrival (69%). Traumatic brain injury was the most common cause of death (66%), followed by anoxia (9.7%) and hemorrhage (8%). Deaths from hemorrhage were most often in patients sustaining gunshot wounds (73% vs. 11% of all other deaths, p < 0.0001), more likely to occur early (100% vs. 50% of all other deaths, p = 0.0009), and all died within 6 hours of arrival. Death from hemorrhage was more common in adolescents (21.4% of children aged 13–17 vs. 6.3% of children aged 0–6, and 0% of children aged 7–12 p = 0.03). The highest case fatality rates were seen in hangings (38.5%) and gunshot wounds (9.6%). CONCLUSION Half of pediatric trauma deaths occurred within 24 hours. Death from hemorrhage was rare, but all occurred within 6 hours of arrival. This is a critical time for interventions for bleeding control to prevent death from hemorrhage in children. Analysis of these deaths can focus efforts on the urgent need for development of new hemorrhage control adjuncts in children. LEVEL OF EVIDENCE Epidemiological study, level IV.

Drivers of blood use in paediatric trauma: A retrospective cohort study

“…Examinations of large, single-centre paediatric trauma care experiences comparable to ours are rare. However, our work does provide an interesting bridge between results from two large recent studies of patterns and outcome of paediatric trauma, one from the University of California Davis at Sacramento (UC Davis) 33 and one from Children's Hospital of Philadelphia (CHOP). 34 Both studies are focused in their approaches to transfusion in paediatric trauma care, that is, considering mechanism of injury but not product use patterns 33 or examination of intra-operative transfusion patterns in trauma surgery without consideration of front-line resuscitation or details of mortality as an outcome.…”

“…However, our work does provide an interesting bridge between results from two large recent studies of patterns and outcome of paediatric trauma, one from the University of California Davis at Sacramento (UC Davis) 33 and one from Children's Hospital of Philadelphia (CHOP). 34 Both studies are focused in their approaches to transfusion in paediatric trauma care, that is, considering mechanism of injury but not product use patterns 33 or examination of intra-operative transfusion patterns in trauma surgery without consideration of front-line resuscitation or details of mortality as an outcome. 34 Theodorou and colleagues 33 use a model similar to ours, that is, retrospective review of the experience of a Level 1 regional adult and paediatric trauma centre for a geographically large and diverse catchment area, and describe a similar study period, patient numbers, distributions and outcomes.…”

“…Theodorou and colleagues 33 use a model similar to ours, that is, retrospective review of the experience of a Level 1 regional adult and paediatric trauma centre for a geographically large and diverse catchment area, and describe a similar study period, patient numbers, distributions and outcomes. Overall mortality in their study was 1.9% (vs. 1.6% for our basic and 1.5% for our non‐burn cohort).…”

Pediatric Traumatic Brain Injury : The Epidemiology in Korea

“…Trauma in the pediatric population is known to be the leading cause of death in Korea along with childhood cancer [ 15 ]. Pediatric trauma patients frequently exhibit head trauma, and it is the most common cause of death among these patients [ 2 , 19 ].…”

Balloons for kids: Anatomic candidacy and optimal catheter size for pediatric resuscitative endovascular balloon occlusion of the aorta

“…H emorrhage is a common cause of potentially preventable death in pediatric patients sustaining life-threatening injuries. [1][2][3] Over the past decade, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been recognized as a potentially lifesaving adjunct for noncompressible hemorrhage below the level of the diaphragm. [4][5][6] A recent study estimated that 46% of pediatric trauma deaths attributed to hemorrhage are amenable to REBOA.…”