Epidemiology and Prehospital Care of Pediatric Unintentional Injuries Among Countries with Different Economic Status in Asia: A Cross-National, Multi-Center Observational Study

Lee, Meng-Chang; Tseng, Wei‐Chieh; Hsu, Li-Min; Shin, Sang Do; Jamaluddin, Sabariah Faizah; Tanaka, Hideharu; Son, Do Ngoc; Hong, Ki Jeong; Riyapan, Sattha; Haedar, Ali; Lin, Hao-Yang; Huang, Edward Pei-Chuan; Hsieh, Ming‐Ju; Huei‐Ming, Matthew; Sun, Jen Tang; Chiang, Wen-Chu

doi:10.1080/10903127.2022.2062804

Cited by 3 publications

(4 citation statements)

References 44 publications

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“…In total, 726 subjects were identified (Fig. 1); 69% were male, median (interquartile range [IQR]) ISS was 12, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] and 83% sustained a blunt mechanism. There were multiple differences identified in demographics and injury characteristics across age groups.…”

Section: Resultsmentioning

confidence: 99%

“…1,4,[15][16][17][18][19] These same factors that differentiate children from adults also distinguish children as they age from infancy to adolescence. 1,4,16,20,21 In the 18 years that encompass childhood, there is ongoing change and maturation of the hemostatic system, inflammatory and immune systems, especially in the first few months of life. [4][5][6][22][23][24][25][26][27] Multiple studies have shown young children have decreased levels of proteins involved in coagulation, fibrinolysis, and natural inhibitors of coagulation without increases in bleeding or thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…It is well established that children are different from adults in their anatomy (body ratios, blood volumes), physiologic responses to trauma (response to stress, thermoregulation, cardiovascular compensation), injury patterns, and epidemiology 1,4,15–19 . These same factors that differentiate children from adults also distinguish children as they age from infancy to adolescence 1,4,16,20,21 . In the 18 years that encompass childhood, there is ongoing change and maturation of the hemostatic system, inflammatory and immune systems, especially in the first few months of life 4–6,22–27 .…”

Section: Discussionmentioning

confidence: 99%

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Age-related changes in thromboelastography profiles in injured children

Morgan

Khalil

Strotmeyer

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND:The role of age in mediating coagulation characteristics in injured children is not well defined. We hypothesize thromboelastography (TEG) profiles are unique across pediatric age groups. METHODS:Consecutive trauma patients younger than 18 years from a Level I pediatric trauma center database from 2016 to 2020 with TEG obtained on arrival to the trauma bay were identified. Children were categorized by age according to the National Institute of Child Health and Human Development categories (infant, ≤1 year; toddler, 1-2 years; early childhood, 3-5 years; older childhood, 6-11 years; adolescent, 12-17 years). Thromboelastography values were compared across age groups using Kruskal-Wallis and Dunn's tests. Analysis of covariance was performed controlling for sex, Injury Severity Score (ISS), arrival Glasgow Coma Scale (GCS) score, shock, and mechanism of injury. RESULTS:In total, 726 subjects were identified; 69% male, median (interquartile range [IQR]) ISS = 12 (5-25), and 83% had a blunt mechanism. On univariate analysis, there were significant differences in TEG α-angle ( p < 0.001), MA ( p = 0.004), and fibrinolysis 30 minutes after MA (LY30) ( p = 0.01) between groups. In post hoc tests, the infant group had significantly greater α-angle (median, 77; IQR, 71-79) and MA (median, 64; IQR, 59-70) compared with other groups, while the adolescent group had significantly lower α-angle (median, 71; IQR, 67-74), MA (median, 60; IQR, 56-64), and LY30 (median, 0.8; IQR, 0.2-1.9) compared with other groups. There were no significant differences between toddler, early childhood, and middle childhood groups. On multivariate analysis, the relationship between age group and TEG values (α-angle, MA, and LY30) persisted after controlling for sex, ISS, GCS, shock, and mechanism of injury. CONCLUSION:Age-associated differences in TEG profiles across pediatric age groups exist. Further pediatric-specific research is required to assess whether the unique profiles at extremes of childhood translate to differential clinical outcomes or responses to therapies in injured children.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Age-related changes in thromboelastography profiles in injured children

Morgan

Khalil

Strotmeyer

et al. 2023

J Trauma Acute Care Surg

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“…Injury severity was categorized on the basis of the excess mortality ratio-adjusted injury severity score (EMR-ISS) as mild (1 ≤ EMR-ISS ≤ 8), moderate (9 ≤ EMR-ISS ≤ 24), and severe and critical (EMR-ISS > 24) 16 , 17 . For the purpose of analysis of major trauma and its risk factors, events with moderate EMR-ISS were combined with those with mild EMR-ISS as non-major trauma group as previous studies 17 – 19 . Major trauma was defined as EMR-ISS > 24.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of non-accidental injuries in children and adolescents in Asia: a cross-national, multicenter cohort study

Wang

Tseng

Lee

et al. 2023

Sci Rep

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Children and adolescents are vulnerable to non-accidental injury. Early identification and prevention rely on detailed epidemiological studies, which are limited in Asia. This retrospective study used the registry data of Pan-Asian Trauma Outcome Study (PATOS) from October 1, 2015 to December, 31, 2020. Pediatric patients (aged < 20 years) with non-accidental injuries were enrolled, which were divided by age into preschool (0–6 years), child (7–12 years), and adolescent (13–19 years) groups. Baseline characteristics, injury epidemiology, and excess mortality ratio-adjusted injury severity score (EMR-ISS) were collected. Major trauma was defined as an EMR-ISS score > 24. The study enrolled 451 patients with non-accidental injuries, accounting for 2.81% of pediatric trauma events presented to an emergency department in the PATOS registry. The overall mortality rate was 0.9%, similar to those in Western countries. Mortality rate was high in preschool children (8.7%, p = 0.017) than in other age groups. The sex-specific incidence was higher in boys (3.10% vs. 2.13%, p = 0.001). In adolescents, more events occurred on the street (25.9%), whereas home remained the most common locale in girls of all ages. In the multivariable regression analysis, abdominal and multiple injuries were risk factors for major trauma.

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