Mortality in severely injured children: experiences of a German level 1 trauma center (2002 – 2011)

Abstract

BackgroundTrauma in pediatric patients is a major cause of death. This study investigated differences between decedents and survivors. Furthermore, an analysis of preventable and potential preventable trauma deaths was conducted and errors in the acute trauma care were investigated.MethodsAll patients aged less than 16 years with an Injury Severity Score (ISS) ≥ 16 upon primary admission to the hospital between July 2002 and December 2011 were included in this study. Decedents were compared with survivors and an analysis of deceased children for preventable and potential preventable deaths was conducted. The acute trauma care was investigated regarding errors in treatment.ResultsSignificant differences were found in Glasgow Coma Scale, Injury Severity Score, Revised Trauma Score, New ISS, Revised Injury Severity Classification, and Trauma and Injury Severity Score. Decedents had a worse head trauma with associated coagulopathy. The overall mortality rate was 13.4%. The majority of death occurred soon after arrival. No long term intensive care unit stay was found.No preventable but one potential preventable death was analyzed. Most errors occurred in fluid volume management and in a delay of starting the therapy for hemorrhage and coagulopathy.Prolonged preclinical rescue time and surgery time within the first 24 hours was found.ConclusionsHead trauma is the determinant factor for mortality in severely injured pediatric patients. Death occurred shortly after arrival and long term intensive care stays might be an exception. In treatment of severely injured children volume management, hemorrhage and coagulopathy management, rescue time, and total surgery time should receive more attention.

Prognostic predictors in polytraumatized children and their impact on outcome

“…7 This study showed that the mean of Hb among patients is 11.6±2.77, another study performed by Schoeneberg C et al, which showed that the mean of HB among patients was 10.6±1.8. 13 This study showed that the mean of Hct on arrival is 33.0 , another study performed by Ciarallo L et al, in a retrospective review conducted on 257 patient, that the mean hematocrit (Hct) was 35.2% on arrival. 14 Regarding the blood transfused to the polytraumatised pediatric patients, 90% of the injured children did not need any blood transfusion, 10% (6 patients) of the polytraumatised children needed blood transfusion when Hct < 30% and this matches the data of Ciarallo L et al, Patients who present with a Hct <30%, or who have polytraumatic injuries had a relatively greater risk of needing a transfusion.…”

“…The study showed that the range of respiratory rate was . According to GCS, this study showed that 67% of the patients have GCS of (13)(14)(15). According to investigations, the mean of Hb among patients is 11.6±2.77.…”

“…14 According to length of resuscitation time among patients, this study showed that the mean time of resuscitation was 35.5±8.23 min., another study performed by Schoeneberg C et al, in a prospective study published, who found that the mean time of resuscitation 51.7±19.2. 13 This might be due to the calculation of the resuscitation time in our emergency department from the start of patient presentation, deleting all the period consumed in transportation of the patient. This is because, not all the paramedics in EMS in Egypt are well trained to start resuscitation of the polytraumatised patient, unlike Germany, resuscitation starts on scene (stay and play) so the transportation time is calculated within the time of resuscitation.…”

Particularities in the Evolution of Mortality by Traumatic Events in the Last 30 Years

“…This particularity is likely of a multifactorial determinism. Most likely, technological development favored the dissemination of information and increased therapeutic possibilities for the pediatric patient, although the currently available data on the treatment of severely traumatized pediatric patients is extremely limited (5).…”

“…However, trauma is among the most important causes of mortality and morbidity in children (0-16 years) (5). A particular and attention-worthy aspect of trauma in children is suspected child abuse, especially in those aged 0-12 months, this particular group being under-tested and often neglected in comparison with those presenting to the physician following accidents or other injuries (6).…”