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Price MS, Raaber N, Gundtoft PH, Trier F. Pediatric trauma over a decade: demographics, mechanisms of injury, and mortality at a major Danish trauma center-a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2025; 33:39. [PMID: 40065415 PMCID: PMC11892122 DOI: 10.1186/s13049-025-01348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 02/17/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND In recent decades, the number of fatal accidents among children and adolescents has declined. Nevertheless, trauma remains a significant cause of death among children and adolescents in high-income countries, despite significant advancements in prevention and care. Pediatric trauma patients differ substantially from adults in terms of their physiology, anatomy, and daily activities; therefore, they show distinct injury patterns and require different care. The aim of this study was to investigate mortality from trauma in pediatric patients admitted by trauma team activation at the Aarhus University Hospital Trauma Center (AUH-TC) in a highly developed country with exceptionally low child mortality, where trauma is a leading cause of death in this age-group. By evaluating trends in demographics, mechanisms of injury, injury severity, and outcomes, this study aims to provide insights into trauma care and outcomes. METHODS This retrospective cohort study included 1,037 pediatric patients (< 18 years old) consecutively admitted by trauma team activation from 1 January 2011 to 31 December 2021. The pediatric patients accounted for 14% of the total trauma population, which consisted of 7307 patients in total. Data on demographics, Injury Severity Score (ISS), mechanism of injury, and 30-day mortality were analyzed. Descriptive statistics were reported. RESULTS Boys accounted for 58% of the patients (n = 595). Falls were the mechanism of injury in 47% (n = 308) of children under 13 years old, while traffic-related injuries accounted for 38% (n = 139) of adolescents aged 14-17 years. Severe injuries (ISS > 15) were associated with traffic accidents in 25% of cases. The number of traumas peaked on weekends (71%) and during the spring/summer (29%). The ISS was greater than 15 in 13% (n = 130) of the patients, and the overall 30-day mortality rate was 1.6% (n = 17). CONCLUSIONS This study found no significant change in pediatric trauma incidence at AUH-TC over a decade. In Denmark, the few children with an ISS above 15 are predominantly injured in traffic accidents, with risk increasing with age. There was a low incidence of patients with an ISS above 15, and mortality rates were lower than in similar studies. These findings on injury patterns and severity may aid in risk assessment, accident prevention, and hospital resource planning. Further research with extended follow-up is recommended to assess potential trends in trauma mechanisms over time.
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Affiliation(s)
- Mette Schytt Price
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark.
- Department of Anesthesiology and Intensive Care, Gødstrup Hospital, Gødstrup, Denmark.
| | - Nikolaj Raaber
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine and Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Per Hviid Gundtoft
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedic, Aarhus University Hospital, Aarhus, Denmark
| | - Frederik Trier
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
- Department of Emergency Medicine, Horsens Regional Hospital, Horsens, Denmark
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Appelhaus S, Schönberg SO, Weis M. [CT in pediatric trauma patients]. ROFO-FORTSCHR RONTG 2025; 197:257-265. [PMID: 39074798 DOI: 10.1055/a-2341-7559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
The decision as to whether to perform a computed tomography (CT) examination in severe pediatric trauma poses a challenge. The therapeutic benefit of computed tomography in injured children is lower compared to adults, while the potential negative effects of ionizing radiation may be higher. Thus, the threshold for CT should be higher. Centers that less frequently treat pediatric cases tend to conduct more whole-body CT examinations than dedicated pediatric trauma centers, indicating a clinical overestimation of injury severity with subsequently unnecessary imaging due to inexperience. On the other hand, a CT scan that is not performed but is actually necessary can also have negative consequences if an injury is detected with a delay. An injured child presents a challenging situation for all involved healthcare providers, and thus requires a structured approach to decision-making.Selective literature review of the benefits and risks of CT in injured children, as well as indications for whole-body and region-specific CT imaging.This article provides an overview of current guidelines, recent insight into radiation protection and the benefits of CT in injured children, and evidence-based decision criteria for choosing the appropriate modality based on the mechanism of injury and the affected body region. · Whole-body CT has less of an influence on treatment decisions and mortality in severely injured children than in adults.. · For radiation protection reasons, the indication should be determined more conservatively in children than in adult trauma patients.. · The indication for CT should ideally be determined separately for each region of the body.. · Ultrasound and MRI are a good alternative for the primary diagnostic workup in many situations.. · Appelhaus S, Schönberg SO, Weis M. CT in pediatric trauma patients. Rofo 2025; DOI 10.1055/a-2341-7559.
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Affiliation(s)
- Stefan Appelhaus
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Stefan O Schönberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Meike Weis
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
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Eimer C, Buschmann C, Deeken J, Kerner T. Mechanical trauma in children and adolescents in Berlin. Forensic Sci Med Pathol 2025; 21:115-122. [PMID: 38625460 PMCID: PMC11953125 DOI: 10.1007/s12024-024-00814-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/17/2024]
Abstract
Management of severe pediatric trauma remains challenging. Injury patterns vary according to patient age and trauma mechanism. This study analyzes trauma mechanisms in deceased pediatric patients. Fatal pediatric trauma cases aged 0-18 years who underwent forensic autopsy in the Federal State of Berlin, Germany, between 2008 until 2018 were enrolled in this retrospective study. Autopsy protocols were analyzed regarding demographic characteristics, trauma mechanisms, injury patterns, resuscitation measures, survival times as well as place, and cause of death. 71 patients (73% male) were included. Traffic accidents (40%) were the leading cause of trauma, followed by falls from height > 3 m (32%), railway accidents (13%), third party violence (11%) and other causes (4%). While children under 14 years of age died mostly due to traumatic brain injury (59%), polytrauma was the leading cause of death in patients > 14 years (55%). Other causes of death were hemorrhage (9%), thoracic trauma (1%) or other (10%). A suicidal background was proven in 24%. In the age group of > 14 years, 40% of all mortalities were suicides. Cardiopulmonary resuscitation was carried out in 39% of all patients. 42% of the patients died at the scene. Children between 0 and 14 years of age died most frequently from traumatic brain injury. In adolescents between 14 and 18 years of age, polytrauma was mostly the cause of death with a high coincidence of suicidal deaths. The frequency of fatal traffic accidents and suicides shows the need to improve accident and suicide prevention for children and adolescents.
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Affiliation(s)
- Christine Eimer
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Kiel, Germany.
| | - Claas Buschmann
- Institute of Legal Medicine, University Hospital Schleswig-Holstein, Kiel / Lübeck, Germany
| | - Jonas Deeken
- Asklepios Medical School GmbH, Lohmühlenstraße 5, Haus P, Hamburg, 20099, Germany
| | - Thoralf Kerner
- Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Therapy, Asklepios Medical Centre, Harburg, Germany
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Bundy R, Taktak J, Berger Z, Nowotny E, Albert I. Paediatric Major Trauma Psychology Service Evaluation: An Early Review of an Integrated Model of Care. CHILDREN (BASEL, SWITZERLAND) 2025; 12:241. [PMID: 40003343 PMCID: PMC11854553 DOI: 10.3390/children12020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 02/04/2025] [Accepted: 02/06/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND Major trauma is a leading cause of death and disability in children and young people (CYP) in the United Kingdom (UK). Since 2012, major trauma centres (MTCs) have been created with specialist expertise to treat patients suffering with lifechanging injuries. Much research has focused on the physical recovery of patients; however, the psychological and psychosocial impacts of major trauma are significant and often neglected/deprioritised. Less is known about this area in relation to a paediatric population. METHODS This service evaluation reports on the first year of an integrated psychological pathway within a London paediatric MTC. The proactive approach involves inpatient and outpatient psychological support, screening children and families for trauma symptoms and emotional distress, offering psychological intervention where required, and liaison with community mental health teams, social care services and third sector organisations. Descriptive statistics are reported on the patient demographics and mechanism of injury, as well as screening scores at 6 weeks and 3 months following the traumatic incident. Patient feedback is also presented. RESULTS The results demonstrate a significant increase in the numbers of children and families offered psychological support following the creation of the pathway and an overwhelmingly positive response from service users. CONCLUSIONS Clinical implications are outlined, and areas for further development are discussed.
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Affiliation(s)
- Rebecca Bundy
- Paediatric Psychological Therapies Service, St George’s Hospital NHS Trust, London SW17 0QT, UK (Z.B.)
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Su ZY, Wei H, Wang WN, Lin YF, He YL, Liu Y, Lin RB, Liu YT, Michael N. Comprehensive epidemiological assessment of trauma incidents at a level I trauma center. World J Clin Cases 2024; 12:6808-6814. [PMID: 39687642 PMCID: PMC11525904 DOI: 10.12998/wjcc.v12.i35.6808] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/12/2024] [Accepted: 08/27/2024] [Indexed: 10/24/2024] Open
Abstract
BACKGROUND The continuous development of social and economic progress and ongoing enhancement of infrastructure construction has led to drastic changes in the occurrence of trauma. AIM To analyze the epidemiological characteristics of trauma in Lanzhou City to provide theoretical references for improving quality of trauma care. METHODS A retrospective analysis of clinical data from 16585 trauma patients treated at the First Hospital of Lanzhou University Trauma Center from November 1, 2021 to October 31, 2023 was conducted. Data including age, sex, time of trauma, cause of trauma, and major injured body parts were statistically analyzed. RESULTS A total of 18235 patients were admitted, with complete data for 16585 cases. Of these, 9793 were male and 6792 were female (male-to-female ratio of 1.44:1). The peak times for trauma occurrence were 10 AM-12 PM and 6-10 PM, and the peak months were from May to October. The leading causes of trauma were falls (45.32%), other trauma (15.88%), road traffic accidents (15.15%), violence (10.82%), cutting/stabbing (9.41%), mechanical injuries (2.65%), winter sports injuries (0.36%), animal bites (0.22%), burns (0.09%), and electrical injuries (0.02%). The distribution of majorly injured body parts showed statistical significance, with limbs/skin being the most affected followed by the head/neck, chest/abdomen, and back. CONCLUSION Medical institutions and government agencies can implement preventive measures and policies based on the characteristics of trauma determined in this study to enhance the quality and level of trauma care.
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Affiliation(s)
- Zhao-Yin Su
- The First Clinical College of Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hui Wei
- School of Stomatology, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Wei-Ning Wang
- School of Stomatology, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yi-Feng Lin
- The First Clinical College of Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yu-Li He
- The First Clinical College of Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yao Liu
- The First Clinical College of Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ru-Bing Lin
- Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen 518000, Guangdong Province, China
| | - Ya-Tao Liu
- Department of Anesthesia, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Nerich Michael
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg 93053, Bavaria, Germany
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Popa Ş, Sârbu I, Bulgaru-Iliescu D, Surd AO, Candussi IL, Popa IP, Ciongradi CI. Injuries to the lower limbs and associated injuries in children and adolescents resulting from road traffic incidents. J Family Med Prim Care 2024; 13:4994-5001. [PMID: 39723007 PMCID: PMC11668480 DOI: 10.4103/jfmpc.jfmpc_486_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/28/2024] [Accepted: 06/14/2024] [Indexed: 12/28/2024] Open
Abstract
Background Fractures occurring in the lower extremities as a result of road traffic accidents (RTAs) can lead to considerable morbidity and constitute a large proportion of nonfatal injuries that necessitate hospitalization. The present study aimed to examine the epidemiology of lower extremity fractures linked with RTAs in pediatric patients. Methods This is a descriptive retrospective research study carried out between 2015 and 2022 at St. Mary's Children's Hospital, Iasi, Romania, targeting the population below the age of 18 years who experienced trauma from RTAs and received treatment from the trauma department. Data pertaining to various aspects, including age distribution, the frequency of accidents, the types of injuries incurred, and surgical treatment, were gathered. Results The findings revealed a total of 358 cases of RTAs, out of which 112 fit the required criteria, and a total of 22 patients, accounting for 19.64%, had open fractures. Conclusion This research provides information on lower extremity fractures and associated injuries in the pediatric population living in urban and rural areas throughout the Moldova region in Romania, subsequent to RTAs. The objective is to deliver the most relevant information at the patient's bedside and provide proper healthcare services.
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Affiliation(s)
- Ştefan Popa
- 2 Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iaşi, Iaşi, Romania
| | - Ioan Sârbu
- 2 Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iaşi, Iaşi, Romania
| | - Diana Bulgaru-Iliescu
- 3 Department of Medical Specialities–Legal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Iaşi, Romania
| | - Adrian Onisim Surd
- Department of Pediatric Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iuliana-Laura Candussi
- Department of Clinical Surgery, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Irene Paula Popa
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
| | - Carmen Iulia Ciongradi
- 2 Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iaşi, Iaşi, Romania
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Molla YD, Gebrehana DA, Nega AM, Alemu HT. Magnitude, mechanism and outcome of pediatric trauma at university of gondar comprehensive specialized hospital, 2023. Heliyon 2024; 10:e39000. [PMID: 39430545 PMCID: PMC11490847 DOI: 10.1016/j.heliyon.2024.e39000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 08/13/2024] [Accepted: 10/04/2024] [Indexed: 10/22/2024] Open
Abstract
Introduction Trauma is the leading cause of mortality among children older than one year. In fact, injuries alone account for a greater number of deaths in children than all other causes combined. Among children under the age of 19, accidental injuries contribute to 65 % of all injury-related deaths. Limited research on childhood trauma in Ethiopia makes it difficult to fully understand its processes, patterns, and effects. In this research, we thoroughly examine the mechanisms, patterns, and outcomes of pediatric trauma cases at the University of Gondar Comprehensive Specialized Hospital, located in Northwest Ethiopia, in the year 2023. Methods This cross-sectional study was conducted on a randomly selected sample of 405 pediatric patients who visited the University of Gondar Comprehensive Specialized Hospital between January 1, 2023, and December 30, 2023. Data were extracted from each medical chart using a structured checklist. The collected data were entered into Epi-data 3.1 for cleaning and analyzed using SPSS version 25. The results were reported using tables and text. Results A total of 405 patients, consisting of 265 males (65.4 %) and 140 females (34.6 %), were included in this study. The patients had a mean age of 7.1 years and a standard deviation of 4.3. The majority of the patients, 303 (74 %), were under the age of 10. More than half of the trauma cases, 222 (54.8 %), occurred in children from rural areas. Fall-down accidents accounted for 187 (46.2 %) of the cases. The second most common cause of trauma was road traffic incidents with collisions, accounting for 53 (13.1 %) cases. In terms of anatomical location, face and head trauma were the most common, accounting for 165 (40.7 %) cases. This was followed by extremity trauma (upper and lower extremities) in 159 (39.3 %) cases and abdomen and pelvic trauma in 103 (25.4 %) cases. The majority of children, specifically 373 (92.1 %), were discharged with improvement. Conclusion Pediatric trauma continues to be a significant issue of public health importance. It is predominantly observed in boys residing in rural areas, with fall-related injuries being the most prevalent cause. Moreover, a majority of the affected individuals experience trauma to the head and face. Therefore, it is imperative to emphasize the necessity of educating the general population about the potential risks associated with pediatric trauma, especially concerning incidents involving falls and motor vehicle collisions. Educating children about the potential hazards linked to activities like climbing trees, crossing roads, and interacting with animals is of utmost importance.
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Affiliation(s)
- Yohannis Derbew Molla
- Department of Surgery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Deresse Abebe Gebrehana
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ahmed Maru Nega
- Department of Surgery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Morton S, Keane S, O'Meara M. Pediatric Intubations in a Semiurban Helicopter Emergency Medicine Service: A Retrospective Review. Air Med J 2024; 43:106-110. [PMID: 38490772 DOI: 10.1016/j.amj.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Although a small proportion of helicopter emergency medical service (HEMS) missions are for pediatric patients, it is recognized that children do present unique challenges. This case series aims to evaluate the intubation first-pass success rate in HEMS pediatric patients for both medical and trauma patients in a UK semiurban environment. METHODS A retrospective review of the computerized records system was performed from January 1, 2015, to July 31, 2022, at 1 UK HEMS. Anonymous data relating to advanced airway interventions in patients < 16 years of age were extracted. Primary analysis related to the first-pass success rate was performed; secondary analysis relating to the initial Glasgow Coma Scale (GCS) of the pediatric patients requiring prehospital anesthesia (rapid sequence induction with drugs) and first-pass success rates by clinician group was also performed. RESULTS Of the pediatric patients, 15.8% required intubation. The overall first-pass success rate for intubation (including in cardiac arrest) was 83.5%; for prehospital anesthesia (drugs administered), it was 98.4%. First-pass success rates were lowest for those under 2 years of age (45.2% without drugs and 87.5% with drugs). There was no difference between physician background in the first-pass success rate. The median GCS for pediatric prehospital anesthesia was 7 versus 5 for adults (P = .012). No children with an initial GCS of 15 had prehospital anesthesia. CONCLUSION The overall intubation first-pass success rates for pediatric patients is high at 83.5% and higher still for prehospital anesthesia (98.4%). However, it remains a rare intervention for clinicians, and children under 2 years of age require special consideration.
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Affiliation(s)
- Sarah Morton
- Essex and Herts Air Ambulance, Colchester, Essex, United Kingdom; Department of Surgery, Imperial College, London, United Kingdom.
| | - Sinead Keane
- Essex and Herts Air Ambulance, Colchester, Essex, United Kingdom
| | - Matt O'Meara
- Essex and Herts Air Ambulance, Colchester, Essex, United Kingdom
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Koh JSK, Ng ZM, Feng JXY, Badron J, Chiang LW, Ang ASY, Chong SL. Caregiver reported long-term outcomes in children with major trauma and traumatic brain injuries: A single-centre retrospective study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:15-22. [PMID: 38920211 DOI: 10.47102/annals-acadmedsg.202387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction We aim to investigate the functional outcomes and long-term health-related quality of life (HRQOL) in children with major trauma associated with traumatic brain injury (TBI). Method We performed a retrospective review of records among patients >2 and ≤16 years old in a tertiary paediatric hospital between January 2014 and October 2019 with major trauma (Injury Severity Score of ≥16) and TBI of all severities. We recorded each child's Glasgow Outcome Scale-Extended Pediatric Version (GOS-E Peds) at 12 months post-injury and Pediatric Quality of Life Inventory (PedsQL) scores at 6 and 12 months post-injury based on the parent proxy-report scales. Results We included 53 patients with a median age of 9.0 years old (interquartile range 2.3-15.5). Most injuries were due to falls (30, 56.6%) or road traffic collisions (15, 28.3%); 41 patients (77.3%) required intensive care while 30 patients (56.6%) underwent neurosurgical intervention. Most patients (43, 81.1%) had GOS-E Peds scores of ≤2 at 12 months post-injury. We reported a significant mean difference between the 6- and 12-month parent-reported scores for physical functioning (6.6, 95% confidence interval [CI] 0.3-12.8, P=0.041), psychosocial functioning (4.1, 95% CI 1.0-7.2, P=0.012) and overall scores (5.0, 95% CI 1.4-8.7, P=0.008). Compared with the validated PedsQL scores, our mean scores were higher across all domains at 12 months. Conclusion With current standard of care, parents of children with major trauma and TBI reported gains in quality of life, physical, psychosocial and overall function between 6 and 12 months post-injury.
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Affiliation(s)
- Joel Song Kai Koh
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Zhi Min Ng
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Jasmine Xun Yi Feng
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Junaidah Badron
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Li Wei Chiang
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Angelina Su Yin Ang
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
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Schuster A, Klute L, Kerschbaum M, Kunkel J, Schaible J, Straub J, Weber J, Alt V, Popp D. Injury Pattern and Current Early Clinical Care of Pediatric Polytrauma Comparing Different Age Groups in a Level I Trauma Center. J Clin Med 2024; 13:639. [PMID: 38276145 PMCID: PMC10816860 DOI: 10.3390/jcm13020639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Introduction: Pediatric polytrauma is a complex condition with unique characteristics and requirements for early clinical care. This study aimed to analyze the injury patterns, early clinical care, and outcomes of pediatric polytrauma patients in a Level I trauma center. The focus was on evaluation between different age groups and the recognition of injuries as potential factors influencing outcomes. Methods: A prospective cohort study model of pediatric polytrauma patients (ISS ≥ 16) was conducted over a 13-year period, stratified by age groups (Group A: 0-5 years; Group B: 6-10 years; Group C: 11-15 years; and Group D: 16-18 years). A comparison of the groups was conducted to examine variations in early clinical care, trauma mechanisms, distribution of affected body regions (as per AIS and ISS criteria), and trauma-related mortality. Additionally, factors contributing to mortality were evaluated. Results: The median age of patients was 16 years, with a male predominance (64.7%). The Injury Severity Score (ISS) varied across age groups, with no significant difference. The 30-day mortality rate was 19.0%, with no significant age-related differences. Trauma mechanisms varied across age groups, with motor vehicle accidents being the most common mechanism in all age groups except 0-5 years, where falls were prevalent. Analysis of injury patterns by AIS body regions indicated that head trauma was a significant predictor of mortality (Hazard Ratio 2.894, p < 0.001), while chest, abdominal, and extremity trauma showed no significant association with mortality. Multiple regression analysis identified the ISS and preclinical GCS as valid predictors of mortality (p < 0.001 and p = 0.006, respectively). Conclusions: While age-related differences in injury severity and clinical interventions were limited, head trauma emerged as a critical predictor of mortality. Early recognition and management of head injuries are crucial in improving outcomes. Additionally, the ISS and preclinical GCS were identified as valid predictors of mortality, emphasizing the importance of early assessment and resuscitation. A tailored approach to pediatric polytrauma care, considering both age and injury patterns, might contribute to survival benefits in this vulnerable population.
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Affiliation(s)
- Anna Schuster
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Lisa Klute
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Jürgen Kunkel
- Department of Pediatrics, KUNO University Children’s Hospital Regensburg, 93053 Regensburg, Germany
| | - Jan Schaible
- Conradia Radiologie München, 80798 München, Germany;
| | - Josina Straub
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Daniel Popp
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
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Popa Ș, Ciongradi CI, Sârbu I, Bîcă O, Popa IP, Bulgaru-Iliescu D. Traffic Accidents in Children and Adolescents: A Complex Orthopedic and Medico-Legal Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1446. [PMID: 37761407 PMCID: PMC10527870 DOI: 10.3390/children10091446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Traffic accidents involving children and adolescents present complex challenges from both the medico-legal and orthopedic standpoints. Despite the implementation of road traffic safety laws, pediatric road traffic injuries continue to be a significant contributor to mortality rates, physical harm, and hospitalization on a global scale. For children and young people, automobile accidents are considered to be the primary culprit of mortality in developed nations. Even in highly developed nations, trauma is a significant factor in infant mortality. Each age category, from childhood to young adulthood, has its fracture patterns, as their skeletons are considerably different from those of adults. The consequences of traffic accidents extend beyond the immediate physical trauma. The medico-legal aspects surrounding these incidents add another layer of complexity, as legal repercussions may affect the responsible adult or parent, particularly in cases involving child fatalities. To effectively address traffic accidents in children and adolescents, a comprehensive approach is necessary. This approach should involve not only medical professionals but also legal experts and policymakers. Collaboration between orthopedic specialists, medico-legal professionals, law enforcement agencies, and relevant government bodies can facilitate the development and implementation of strategies aimed at prevention, education, the enforcement of traffic laws, and improved infrastructure. By addressing both the medical and legal aspects, it is possible to enhance road safety for children and adolescents, reducing the incidence of injuries and their associated long-term consequences. In this review, we aimed to summarize traffic accidents in children and adolescents from a complex orthopedic and medico-legal approach.
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Affiliation(s)
- Ștefan Popa
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Carmen Iulia Ciongradi
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Ioan Sârbu
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Ovidiu Bîcă
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Irene Paula Popa
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Diana Bulgaru-Iliescu
- 3rd Department of Medical Specialities–Legal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
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Almalki MM, Almalki ME, Alsulaimani N, Tariq S, Alqahtani T, Baalaraj F, Ageel M. Epidemiology of pediatric trauma in Makkah, Kingdom of Saudi Arabia: An observational cohort study. Saudi Med J 2023; 44:808-814. [PMID: 37582569 PMCID: PMC10425630 DOI: 10.15537/smj.2023.44.8.20230292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVES To explore the epidemiology and patterns of pediatric trauma in addition to length of hospital stay and outcome. METHODS A single-center retrospective study of 605 patients aged 14 years and younger was carried out from January to December 2022. The study included all patients who experienced intentional or unintentional trauma aged 14 years or below in 2022 and excluded trauma that did not prompt an emergency room visit. RESULTS Most pediatric trauma cases involved boys (69.1%, n=418), and girls comprised only 30.9% (n=187). Trauma was most common in children one to 5 years old (41.5%, n=251). Falling from a height was the most common mode of injury in both girls and boys (n=253, 41.8%). The most common body parts involved were the extremities (n=357, 59%), followed by the head (n=210, 34.7%). Most children were transferred to hospital via emergency medical services (n=234, 38.7%). In most cases, the child was admitted to the surgical ward (n=458, 75.7%), while others were managed in the emergency department without admission (n=93, 15.4%). Most patients were stable after receiving standard care (n=558, 92.2%). CONCLUSION To reduce health care expenses and improve public health outcomes, prioritizing preventive measures is crucial. This includes increasing public awareness, implementing safety protocols, and enacting government regulations to prevent avoidable injuries.
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Affiliation(s)
- Mansour M. Almalki
- From the College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Mohammed E. Almalki
- From the College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Nedaa Alsulaimani
- From the College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Shahad Tariq
- From the College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Taif Alqahtani
- From the College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Fawaz Baalaraj
- From the College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Mohammed Ageel
- From the College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
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Schuetze K, Pankratz C, Schütze S, Zieger J, Gebhard F, Cintean R. Road Traffic Accidents, Climbing Frames, or Trampolines: What Harms Children in the 2020s? Cureus 2023; 15:e35781. [PMID: 37025721 PMCID: PMC10072073 DOI: 10.7759/cureus.35781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
Background In the modern Western world, activities and the daily routine of children have changed over time. Detailed analyses of the mechanisms of injuries and current fracture patterns in children are rare. The aim of the study was to elicit and investigate the most dangerous leisure and sporting activities leading to fractures in children today. Materials and methods This is a retrospective study focusing on children that were treated in a level-one trauma center in Germany between 2015 and 2020. All children who were 14 years of age or younger and suffered a traumatic injury treated in our emergency department were included in this study. From the database, mechanisms of injury, type of injury, age, and gender were analyzed. Results The study included 12508 patients, including 7302 males and 5206 females. Among the 10 most common mechanisms of injury were collisions (8.6%), falls (7.7%), injuries while playing (6.1%) or while running or walking (5.9%), soccer (5.9%), bicycle accidents (3.8%), and trampoline falls (3.4%). Road traffic accidents involving passengers or pedestrians caused 3.3% of the injuries but were the most common cause of death. The most common mechanisms of injury causing a fracture were falls, playing soccer, and bicycle accidents. Sorting the mechanisms of injury by the percentage that caused a fracture, the most dangerous activities were falling from heights above 2 meters, skiing and snowboarding, climbing and bouldering, skateboarding, and horseback riding. In the five-year study period, four out of six children died due to road traffic accidents. Conclusion Injured children must be provided with the best quality of care 24/7 in orthopedic trauma departments and have to be kept as a focus in the training of orthopedic trauma surgeons. Road traffic accidents are still the main cause of death in children, but they are overall less common. Falls and sports activities are the most likely to cause a fracture.
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Sweet AAR, de Bruin IGJ, Peek J, IJpma FFA, van Baal MCPM, Leenen LPH, Houwert RM. Epidemiology and outcomes of traumatic chest injuries in children: a nationwide study in the Netherlands. Eur J Pediatr 2023; 182:1887-1896. [PMID: 36807757 PMCID: PMC10167109 DOI: 10.1007/s00431-023-04828-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/21/2023]
Abstract
UNLABELLED Thoracic injuries are infrequent among children, but still represent one of the leading causes of pediatric mortality. Studies on pediatric chest trauma are dated, and little is known of outcomes in different age categories. This study aims to provide an overview of the incidence, injury patterns, and in-hospital outcomes of children with chest injuries. A nationwide retrospective cohort study was performed on children with chest injuries, using data from the Dutch Trauma Registry. All patients admitted to a Dutch hospital between January 2015 and December 2019, with an abbreviated injury scale score of the thorax between 2 and 6, or at least one rib fracture, were included. Incidence rates of chest injuries were calculated with demographic data from the Dutch Population Register. Injury patterns and in-hospital outcomes were assessed in children in four different age groups. A total of 66,751 children were admitted to a hospital in the Netherlands after a trauma between January 2015 and December 2019, of whom 733 (1.1%) sustained chest injuries accounting for an incidence rate of 4.9 per 100,000 person-years. The median age was 10.9 (interquartile range (IQR) 5.7-14.2) years and 62.6% were male. In a quarter of all children, the mechanisms were not further specified or unknown. Most prevalent injuries were lung contusions (40.5%) and rib fractures (27.6%). The median hospital length of stay was 3 (IQR 2-8) days, with 43.4% being admitted to the intensive care unit. The 30-day mortality rate was 6.8%. CONCLUSION Pediatric chest trauma still results in substantial adverse outcomes, such as disability and mortality. Lung contusions may be inflicted without fracturing the ribs. This contrasting injury pattern compared to adults underlines the importance of evaluating children with chest injuries with additional caution. WHAT IS KNOWN • Chest injuries are rare among children, but represent one of the leading causes of pediatric mortality. • Children show distinct injury patterns in which pulmonary contusions are more prevalent than rib fractures. WHAT IS NEW • The proportion of chest injuries among pediatric trauma patients is currently lower than reported in previous literature, but still leads to substantial adverse outcomes, such as disabilities and death. • The incidence of rib fractures gradually increases with age and in particular around puberty when ossification of the ribs becomes completed. The incidence of rib fractures among infants is remarkably high, which is strongly suggestive for nonaccidental trauma.
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Affiliation(s)
- Arthur A R Sweet
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Ivar G J de Bruin
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jesse Peek
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank F A IJpma
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Mark C P M van Baal
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick M Houwert
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Cintean R, Eickhoff A, Zieger J, Gebhard F, Schütze K. Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients. Eur J Trauma Emerg Surg 2023; 49:451-459. [PMID: 36001123 PMCID: PMC9925538 DOI: 10.1007/s00068-022-02088-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pediatric traumas are common and remain a unique challenge for trauma surgeons. Demographic data provide a crucial source of information to better understand mechanisms and patterns of injury. The aim of this study was to provide this information to improve treatment strategies of potentially preventable morbidity and mortality in children. MATERIAL AND METHODS A retrospective review of every pediatric trauma treated in the emergency department (ED) between 2015 and 2019 was performed. Inclusion criteria were the age between 0 and 14 years and admission to the ED after trauma. Demographic data, time of presentation, mechanism of injury and pattern of injury, treatment, and outcome were analyzed. Different injury patterns were assessed in relation to age group, sex, mechanism of injury and treatment. RESULTS A total of 12,508 patients were included in this study. All patients were stratified into five age groups: babies under the age of 1 (8.8%), toddlers between 1 and 3 (16.8%), preschool children between 4 and 6 (19.3%), young school children between 7 and 10 (27.1%), and young adolescents between 11 and 14 (27.9%). The predominant sex in all age groups was male. 47.7% of patients were admitted between 4 and 10 pm; 14.8% of the patients arrived between 10 pm and 8 am. Peak months of admissions were May to July. Overall, 2703 fractures, 2924 lacerations and superficial tissue injury, 5151 bruises, 320 joint dislocations, 1284 distortions, 76 burns, and 50 other injuries were treated. Most common mechanisms for fractures were leisure activities, falls, and sports-related activities. Forearm fractures were the most common fractures (39.5%) followed by humerus fractures (14%) and fractures of the hand (12.5%). A total of 700 patients with fractures (25.9%) needed surgery. 8.8% of all patients were hospitalized for at least one day. 4 patients died in the hospital (0.03%). CONCLUSION Despite of higher risk, severe injuries in children are rare. Minor injuries and single fractures are common. Treatment should be managed in specialized centers to ensure an interdisciplinary care and fast recovery. Peak times in the late afternoon and evening and summer months should be taken into consideration of personnel planning.
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Affiliation(s)
- Raffael Cintean
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Alexander Eickhoff
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Jasmin Zieger
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Florian Gebhard
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Konrad Schütze
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Hojo K, Abe T, Saito K, Sasaki A, Ochiai H. A pediatric case of multiple trauma with impending cardiac arrest due to hemorrhagic shock successfully treated with resuscitative thoracotomy: A case report. Acute Med Surg 2023; 10:e867. [PMID: 37409217 PMCID: PMC10318262 DOI: 10.1002/ams2.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/23/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
Background The effectiveness of resuscitative thoracotomy (RT) in pediatric patients with multiple trauma is limited. We present a pediatric case of multiple trauma successfully treated with RT. Case Presentation A 9-year-old boy was injured after falling down stairs. On arrival, his blood pressure was unmeasurable, and the carotid artery pulse was barely palpable. Sonographic assessment indicated intra-abdominal hemorrhage. RT and aortic cross-clamping were performed, and he received a blood transfusion, after which his circulatory status recovered. Laparotomy indicated an inferior mesenteric vein injury that was sutured. Ten hours after arrival, an acute epidural hematoma was observed and treated with an emergency craniotomy. The patient's condition remained stable and he was discharged on the 101st day. Conclusion RT may save the life of patients with multiple trauma, even pediatric patients, if performed in a timely manner, based on the diagnosis of hemorrhagic shock, along with rapid transfusion and hemostatic intervention.
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Affiliation(s)
- Kento Hojo
- Department of Emergency and Critical Care MedicineUniversity of MiyazakiMiyazakiJapan
- Department of Internal MedicineNational Health Insurance Misato Town, Saigo HospitalMisato, MiyazakiJapan
| | - Tomohiro Abe
- Department of Emergency and Critical Care MedicineUniversity of MiyazakiMiyazakiJapan
- Cardiovascular Biology Research ProgramOklahoma Medical Research FoundationOklahoma CityOklahomaUSA
| | - Katsutoshi Saito
- Department of Emergency and Critical Care MedicineUniversity of MiyazakiMiyazakiJapan
| | - Akira Sasaki
- Department of Emergency and Critical Care MedicineUniversity of MiyazakiMiyazakiJapan
| | - Hidenobu Ochiai
- Department of Emergency and Critical Care MedicineUniversity of MiyazakiMiyazakiJapan
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Akgül F, Er A, Çağlar A, Ulusoy E, Çitlenbik H, Duman M, Yılmaz D. Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. ULUS TRAVMA ACIL CER 2022; 28:933-939. [PMID: 35775672 PMCID: PMC10493837 DOI: 10.14744/tjtes.2021.48961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Thoracoabdominal injuries (TAI) are an important cause of trauma-related morbidity in children. Early and correct intervention is essential to reduce mortality. We aimed to determine factors associated with mortality and the need for intensive care in TAI. METHODS The children admitted to the pediatric emergency department of a tertiary care hospital with TAI in a 6-year-period were enrolled. Demographic data; mechanism of injuries; clinical, laboratory and imaging findings; length of hospital and intensive care unit (ICU) stay; invasive procedures and medical treatments; surgical interventions; and survival outcomes were recorded. RESULTS The median age of the 136 children was 9 (IQR: 5-14) years and 72.8% were male. The vast majority of injuries were caused by blunt trauma (92.7%). Pulmonary contusion, pneumothorax, splenic, and liver injuries were the most common diagnoses. Motor vehicle accidents were seen in more than half of the cases (52.2%). The median length of hospital stay was 5 (IQR: 2-8) days; 21 patients were hospitalized in the ICU (15.4%). The need for intensive care was higher in patients with lower Glasgow Coma Scale (GCS) scores and lower Pediatric Trauma Scores (PTSs), in the presence of multiple injuries, pulmonary contusion, and pneumothorax (p<0.001). Mortality was seen in nine patients, eight of whom had multiple injuries. The mortality rate was higher in patients with pulmonary contusion and pneumothorax (p=0.002 and p=0.003, respectively). The PTS and GCS were found to be lower in patients who died in hospital (p<0.001). Prolongation of coagulation parameters and hyperglycemia was more common in the non-survivor group (p=0.005 and p=0.004, respectively). CONCLUSION Although thoracoabdominal trauma is not common in childhood, it is an important part of trauma-associated mortality. Multiple injuries, pulmonary contusion, pneumothorax, lower GCS, and PTSs can be a sign of serious injuries to which physicians must be alert.
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Affiliation(s)
- Fatma Akgül
- Department of Pediatric Emergency Care, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Anıl Er
- Department of Pediatric Emergency Care, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Aykut Çağlar
- Department of Pediatric Emergency Care, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Emel Ulusoy
- Department of Pediatric Emergency Care, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Hale Çitlenbik
- Department of Pediatric Emergency Care, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Murat Duman
- Department of Pediatric Emergency Care, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Durgül Yılmaz
- Department of Pediatric Emergency Care, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
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Dagnaw Y, Fenta B, Yetwale A, Biyazin T, Sayih A, Dessalegn N, Adugnaw E, Ali F, Tesfa Y. Mechanisms, Pattern and Outcome of Pediatrics Trauma At Agaro General Hospital, Southwest Ethiopia, 2021. Health Serv Res Manag Epidemiol 2022; 9:23333928221101975. [PMID: 35633833 PMCID: PMC9130848 DOI: 10.1177/23333928221101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Over 80% of trauma related deaths in children occur in low income and middle-income countries including Ethiopia. Trauma affects several aspects of child life and is still a major concern. Despite the Ethiopian federal ministry of health (FMoH) conducting away different trials, there was an increased burden and high projection of pediatric trauma. In Ethiopia, There is insufficient evidence about the mechanisms, patterns and outcomes of pediatric trauma including this study area, Therefore this study aimed to assess the mechanisms, patterns, and outcomes of pediatric trauma in Agaro General Hospital, Southwest Ethiopia, 2021. Methods and Materials This cross-sectional study was study conducted on randomly selected 405pediatric patients who visited the Agaro General Hospital between 1/1/2018 and 30/8/2021. Data were extracted from each medical chart using a structured checklist. Data were entered into Epi-data 4.4.2.1for cleaning and analyzed using SPSS version 24. Tables, charts, and text are used to report the results. Results A total of 405 patients were included in the study. This study revealed that majority 271 (66.9%) of injured children were males. Most 188 (46.4%) of the traumas were occurred on the street. Fall down injury were the most common 151(37.3%) cause of trauma, followed by road traffic accidents 98 (24.2%). Trauma caused by falls accounted for 43.7% and 34.4% % of all traumas in the 5–12 year and the <5 year age groups respectively. Most 126 (31.1%) of the subjects were exposed to head and face trauma. Majority 256 (63.2%) of children were discharged with improvement, while12 (3.0%) of them have died. Conclusions Pediatric trauma remains a major public health concern. Most of trauma occurred among boys and falldown injury was the most frequent trauma, and the majority of the subjects were exposed to head and face trauma. Therefore, children should receive safety precautions, more supervision, and identification of specific risk factors for these injuries, and should be prohibited from risky practices by concerned bodies including families and traffic officers.
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Affiliation(s)
- Yalemtsehay Dagnaw
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Belete Fenta
- School of Midwifery, Jimma University, Jimma, Oromia Regional State, Ethiopia
| | - Aynalem Yetwale
- School of Midwifery, Jimma University, Jimma, Oromia Regional State, Ethiopia
| | - Tsegaw Biyazin
- School of Midwifery, Jimma University, Jimma, Oromia Regional State, Ethiopia
| | - Alemayehu Sayih
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Nigatu Dessalegn
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Emebet Adugnaw
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Fatuma Ali
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Yitbarek Tesfa
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
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Predictors of 12 month functional outcomes and length of stay of severely injured children in NSW, Australia. A longitudinal multi-centre study. Injury 2022; 53:1684-1689. [PMID: 35031107 DOI: 10.1016/j.injury.2021.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/16/2021] [Accepted: 12/31/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The majority of paediatric injury outcomes studies focus on mortality rather than the impact on long-term quality of life, health care use and other health-related outcomes. This study sought to determine predictors of 12-month functional and psychosocial outcomes for children sustaining major injury in NSW. METHODS The study included all children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW at a paediatric trauma centre (PTC). Children were identified through the three PTCs and NSW Trauma Registry. The paediatric Quality of Life Inventory (PedsQL) and EuroQol five-dimensional EQ-5D-Y were used to measure HRQoL post-injury, completed via parent/carer proxy recruited through NSW PTCs. RESULTS There were 510 children treated at the three NSW PTCs during the 15-month study period. The mean (SD) age was 6.7 (6.0) years, with a median NISS (New Injury Severity Score) of 11 (IQR: 9-18). Regression analysis showed worse psychosocial health at twelve months was associated with hospital length of stay (LoS) and number of body regions injured (F2,65 = 5.85, p = 0.005). Physical outcome was associated with LoS and intensive care unit (ICU) admission (F2,66 = 13.48, p < 0.001). Hospital LoS was significantly associated with NISS and head injury (F2,398 = 51.5, p < 0.001). CONCLUSION Hospital length of stay and polytrauma are independent factors that negatively influence psychological and physical outcomes of children with major injuries. Early intervention to enable emotional well-being, discharge home and long-term follow up such as dedicated family support and rehabilitation at home could reduce preventable poor outcomes.
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Ackah M, Gazali Salifu M, Osei Yeboah C. Estimated incidence and case fatality rate of traumatic brain injury among children (0-18 years) in Sub-Saharan Africa. A systematic review and meta-analysis. PLoS One 2021; 16:e0261831. [PMID: 34968399 PMCID: PMC8717989 DOI: 10.1371/journal.pone.0261831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Studies from Sub-Saharan Africa (SSA) countries have reported on the incidence and case fatality rate of children with Traumatic Brain Injury (TBI). However, there is lack of a general epidemiologic description of the phenomenon in this sub-region underpinning the need for an accurate and reliable estimate of incidence and outcome of children (0-18 years) with TBI. This study therefore, extensively reviewed data to reliably estimate incidence, case fatality rate of children with TBI and its mechanism of injury in SSA. METHODS Electronic databases were systematically searched in English via Medline (PubMed), Google Scholar, and Africa Journal Online (AJOL). Two independent authors performed an initial screening of studies based on the details found in their titles and abstracts. Studies were assessed for quality/risk of bias using the modified Newcastle-Ottawa Scale (NOS). The pooled case fatality rate and incidence were estimated using DerSimonian and Laird random-effects model (REM). A sub-group and sensitivity analyses were performed. Publication bias was checked by the funnel plot and Egger's test. Furthermore, trim and fill analysis was used to adjust for publication bias using Duval and Tweedie's method. RESULTS Thirteen (13) hospital-based articles involving a total of 40685 participants met the inclusion criteria. The pooled case fatality rate for all the included studies in SSA was 8.0%; [95% CI: 3.0%-13.0%], and the approximate case fatality rate was adjusted to 8.2%, [95% CI:3.4%-13.0%], after the trim-and-fill analysis was used to correct for publication bias. A sub-group analysis of sub-region revealed that case fatality rate was 8% [95% CI: 2.0%-13.0%] in East Africa, 1.0% [95% CI: 0.1% -3.0%] in Southern Africa and 18.0% [95% CI: 6.0%-29.0%] in west Africa. The pooled incidence proportion of TBI was 18% [95% CI: 2.0%-33.0%]. The current review showed that Road Traffic Accident (RTA) was the predominant cause of children's TBI in SSA. It ranged from 19.1% in South Africa to 79.1% in Togo. CONCLUSION TBI affects 18% of children aged 0 to 18 years, with almost one-tenth dying in SSA. The most common causes of TBI among this population in SSA were RTA and falls. TBI incidence and case fatality rate of people aged 0-18 years could be significantly reduced if novel policies focusing on reducing RTA and falls are introduced and implemented in SSA.
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Affiliation(s)
- Martin Ackah
- Department of Physiotherapy, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Mohammed Gazali Salifu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
- Policy Planning Budgeting Monitoring and Evaluation Directorate, Ministry of Health, Accra, Ghana
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Paediatric major trauma: demographics, management and outcomes at Cork University Hospital. Ir J Med Sci 2021; 191:2343-2350. [PMID: 34743298 DOI: 10.1007/s11845-021-02848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To establish the demographics, injury patterns, management and outcomes of paediatric major trauma patients at Cork University Hospital (CUH). METHODS This was a retrospective, descriptive study. Data from all CUH paediatric major trauma cases that were recorded in the Trauma Audit and Research Network (TARN) database from January 2014 to July 2018 were examined. All patients were under the age of sixteen and fulfilled NOCA's Major Trauma Audit inclusion criteria (Appendix). RESULTS A total of 163 patients were included, with a mean age of 9 years (standard deviation 4.8 years); 33% (n = 54) had an Injury Severity Score (ISS) > 15. The majority (62%) was male. Paediatric trauma accounts for 6% of TARN eligible cases at CUH. The most common mechanism of injury was falls < 2 m (35%) followed by road trauma (26%). Fifty-one percent were brought by ambulance; 45% self presented. Six percent were transferred out of CUH for definitive care. Limb injuries occurred in 45% of patients (n = 74) and head injury in 29% (n = 47). Head injuries were isolated in 62% (n = 29). Injuries to chest or face were rarely isolated. The mean ISS was 12 (SD 7). The majority of patients (62%) presented out of hours. The median length of stay was 5 days (Interquartile range 3-8 days). Four patients died (mortality rate 2%), all male, two due to head injury and two due to asphyxia by hanging. CONCLUSIONS Paediatric trauma is of low volume, creating challenges in terms of preparedness. The annual number of paediatric major trauma presentations to CUH, including road trauma cases, remains roughly constant.
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22
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Kuok CI, Chan WKY, Kwok AWL. What and who should we focus in pediatric injury prevention - An analysis of critical pediatric trauma in a major trauma center in Hong Kong. Pediatr Neonatol 2021; 62:620-627. [PMID: 34330685 DOI: 10.1016/j.pedneo.2021.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/18/2021] [Accepted: 05/20/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Understanding trauma epidemiology is essential in formulating region-specific strategies for injury prevention. Our study aimed to evaluate the characteristics and clinical outcomes of critical pediatric trauma requiring intensive care in Hong Kong. METHODS A retrospective analysis was performed on pediatric patients who were injured and admitted to the pediatric intensive care unit (PICU), Queen Elizabeth Hospital, Hong Kong between 2014 and 2018. Clinical features of patients who sustained injuries before and after 2 years old were compared. RESULTS 141 patients were admitted to the PICU due to trauma during the study period. Most patients sustained injuries due to fall (48.2%) or road traffic injuries (34.0%), with the latter more common in older patients. Two (1.4%) patients died due to the trauma. The majority (95.0%) of the survivors had good recovery assessed by Glasgow Outcome Scale. Patients younger than 2 years old were mostly injured at home due to fall while left unattended. Children in this age group were more likely to receive interventions, including mechanical ventilation (OR 2.61; 95% CI 1.15-5.95), anti-epileptic medications (OR 2.61; 95% CI 1.17-5.83), blood transfusion (OR 5.37; 95% CI 2.29-12.60) and inotropic support (OR 4.08; 95% CI 1.31-12.70), and require longer hospitalization (PICU stay 2.5 vs. 1.5 days, p = 0.011; hospital stay 10.9 vs. 6.9 days, p = 0.012). CONCLUSION Fall injuries and road traffic injuries were common etiologies of critical pediatric trauma in Hong Kong. Patients younger than 2 years old had worse clinical outcomes. Parental education on home safety and importance of close supervision should be emphasized in this age group.
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Affiliation(s)
- Chon In Kuok
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong.
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Ku D, Kim KH. Clinical Analysis of Trauma Characteristics Among Preschool-Aged Children. JOURNAL OF ACUTE CARE SURGERY 2020. [DOI: 10.17479/jacs.2020.10.2.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Petroze RT, Martin AN, Ntaganda E, Kyamanywa P, St‐Louis E, Rasmussen SK, Calland JF, Byiringiro JC. Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry. BJS Open 2020; 4:78-85. [PMID: 32011812 PMCID: PMC6996633 DOI: 10.1002/bjs5.50222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/29/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Child survival initiatives historically prioritized efforts to reduce child morbidity and mortality from infectious diseases and maternal conditions. Little attention has been devoted to paediatric injuries in resource-limited settings. This study aimed to evaluate the demographics and outcomes of paediatric injury in a sub-Saharan African country in an effort to improve prevention and treatment. METHODS A prospective trauma registry was established at the two university teaching campuses of the University of Rwanda to record systematically patient demographics, prehospital care, initial physiology and patient outcomes from May 2011 to July 2015. Univariable analysis was performed for demographic characteristics, injury mechanisms, geographical location and outcomes. Multivariable analysis was performed for mortality estimates. RESULTS Of 11 036 patients in the registry, 3010 (27·3 per cent) were under 18 years of age. Paediatric patients were predominantly boys (69·9 per cent) and the median age was 8 years. The mortality rate was 4·8 per cent. Falls were the most common injury (45·3 per cent), followed by road traffic accidents (30·9 per cent), burns (10·7 per cent) and blunt force/assault (7·5 per cent). Patients treated in the capital city, Kigali, had a higher incidence of head injury (7·6 per cent versus 2·0 per cent in a rural town, P < 0·001; odds ratio (OR) 4·08, 95 per cent c.i. 2·61 to 6·38) and a higher overall injury-related mortality rate (adjusted OR 3·00, 1·50 to 6·01; P = 0·019). Pedestrians had higher overall injury-related mortality compared with other road users (adjusted OR 3·26, 1·37 to 7·73; P = 0·007). CONCLUSION Paediatric injury is a significant contributor to morbidity and mortality. Delineating trauma demographics is important when planning resource utilization and capacity-building efforts to address paediatric injury in low-resource settings and identify vulnerable populations.
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Affiliation(s)
- R. T. Petroze
- Montreal Children's Hospital, Division of Paediatric General and Thoracic SurgeryMontrealQuebecCanada
- University of Florida, Division of Pediatric SurgeryGainesvilleFloridaUSA
- Department of SurgeryUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - A. N. Martin
- Department of SurgeryUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - P. Kyamanywa
- University of RwandaKigaliRwanda
- Kampala International UniversityKampalaUganda
| | - E. St‐Louis
- Montreal Children's Hospital, Division of Paediatric General and Thoracic SurgeryMontrealQuebecCanada
| | - S. K. Rasmussen
- Department of SurgeryUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - J. F. Calland
- Department of SurgeryUniversity of VirginiaCharlottesvilleVirginiaUSA
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Hon KL, Huang S, Poon WS, Cheung HM, Ip P, Zee B. Mortality And Morbidity of Severe Traumatic Brain Injuries; A Pediatric Intensive Care Unit Experience Over 15 Years. Bull Emerg Trauma 2019; 7:256-262. [PMID: 31392225 DOI: 10.29252/beat-070308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To determine the mortality, morbidity, types of intracranial hemorrhages, and factors associated with length of stay (LOS) associated with accidental traumatic brain injury (TBI) at a pediatric intensive care unit (PICU) of a regional trauma center in an Asian city. Methods This study is a retrospective review of types of head injury, mortality and morbidity demographics of patients admitted to a PICU with TBI. All patients with accidental TBI were included, namely road traffic injury (RTI) and fall, and their demographics compared. Non-accidental injuries (NAI) were excluded. Results 95 children (78% males) were admitted to a PICU with RTI or falls from 2002 to 2017. They accounted for 3.7% of PICU admissions. Comparing with falls, victims of RTI were older (p<0.001) and more likely to suffer from skull fracture (p=0.017). There were 4 deaths with falls (6.8%) but none with RTI. Subarachnoid hemorrhages, extradural hemorrhages, the use of mechanical ventilation, inotropes and neurological supports were associated with longer LOS in PICU in these injuries (p<0.001). Conclusion A longer PICU LOS is associated with extradural and subarachnoid hemorrhages, usage of inotropes, mechanical ventilation and neurological supports in falls and RTI. Three-quarters of victims are males. Preventive health education should be especially directed to boys to reduce severe TBI in this Asian city.
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Affiliation(s)
- Kam Lun Hon
- Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Siwei Huang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Hon Ming Cheung
- Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Benny Zee
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
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Terboven T, Leonhard G, Wessel L, Viergutz T, Rudolph M, Schöler M, Weis M, Haubenreisser H. Chest wall thickness and depth to vital structures in paediatric patients - implications for prehospital needle decompression of tension pneumothorax. Scand J Trauma Resusc Emerg Med 2019; 27:45. [PMID: 30992028 PMCID: PMC6469218 DOI: 10.1186/s13049-019-0623-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/26/2019] [Indexed: 11/20/2022] Open
Abstract
Background Recommendations regarding decompression of tension pneumothorax in small children are scarce and mainly transferred from the adult literature without existing evidence for the paediatric population. This CT-based study evaluates chest wall thickness, width of the intercostal space (ICS) and risk of injury to vital structures by needle decompression in children. Methods Chest wall thickness, width of the intercostal space and depth to vital structures were measured and evaluated at 2nd ICS midclavicular (MCL) line and 4th ICS anterior axillary line (AAL) on both sides of the thorax using computed tomography (CT) in 139 children in three different age groups (0, 5, 10 years). Results Width of the intercostal space was significantly smaller at the 4th ICS compared to the 2nd ICS in all age groups on both sides of the thorax. Chest wall thickness was marginally smaller at the 4th ICS compared to the 2nd ICS in infants and significantly smaller at 4th ICS in children aged 5 years and 10 years. Depth to vital structure for correct angle of needle entry was smaller at the 4th ICS in all age groups on both sides of the thorax. Incorrect angle of needle entry however is accompanied by a higher risk of injury at 2nd ICS. Furthermore, in some children aged 0 and 5 years, the heart or the thymus gland were found directly adjacent to the thoracic wall at 2nd ICS midclavicular line. Conclusion Especially in small children risk of iatrogenic injury to vital structures by needle decompression is considerably high. The 4th ICS AAL offers a smaller chest wall thickness, but the width of the ICS is smaller and the risk of injury to the intercostal vessels and nerve is greater. Deviations from correct angle of entry however are accompanied by higher risk of injury to intrathoracic structures at the 2nd ICS. Furthermore, we found the heart and the thymus gland to be directly adjacent to the thoracic wall at the 2nd ICS MCL in a few children. From our point of view this puncture site can therefore not be recommended for decompression in small children. We therefore recommend 4th ICS AAL as the primary site of choice. Electronic supplementary material The online version of this article (10.1186/s13049-019-0623-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tom Terboven
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Georg Leonhard
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Lucas Wessel
- Department of Paediatric Surgery, Mannheim University Medical Center, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tim Viergutz
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marcus Rudolph
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DRF Stiftung Luftrettung gemeinnützige AG, Filderstadt, Germany
| | - Michael Schöler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Meike Weis
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Abstract
Objectives Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma. Methods This is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs). Results There were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns. Intra-abdominal and intra-thoracic injuries accounted for 3 and 2% of injuries. The mechanisms and injuries sustained differed significantly between HICs and LMICs. Median length of stay was 1 day and 19% required an operative intervention; this did not differ significantly between HICs and LMICs. No mortality and morbidity was reported from HICs. In LMICs, in-hospital morbidity was 4.0% and mortality was 0.8%. Conclusion The spectrum of paediatric trauma varies significantly, with different injury mechanisms and patterns in LMICs. Healthcare structure, access to paediatric surgery and trauma prevention strategies may account for these differences. Trauma registries are needed in LMICs for future research and to inform local policy.
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Paediatric pelvic fractures: A review of 2 cohorts over 22 years. Injury 2018; 49:613-617. [PMID: 29448991 DOI: 10.1016/j.injury.2018.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 02/02/2023]
Abstract
AIMS The aim of this retrospective review was to identify all children that presented to our institution with a pelvic or acetabular fracture and to compare these children to a previous cohort of paediatric pelvic fractures that we have reported. PATIENTS 53 children under the age of 16 were identified over a ten year period. METHODS We reviewed our trauma database, hospital records and radiological imaging to determine the age, gender, fracture pattern, associated injuries and management of the pelvic fracture. RESULTS There were 32 boys and 21 girls. Mean age of the boys was 8.8 years and the girls 10.7 years. In seven children the pelvic fracture was an isolated injury and in the remaining 46 children, there were 113 additional injuries. 56% of the additional injuries was either a fracture/dislocation (37%) or a head injury (19%). Compared to our first cohort, we had a larger number of children in the second cohort. Age, sex distribution, mechanism of injury was similar in the two groups. In this current cohort, use of CT scan imaging was more frequent, there were more unstable pelvic fracture patterns identified, ISS scores were higher and mortality was lower. CONCLUSION We have seen more children with more severe injuries, higher ISS scores but a lower mortality rate.
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Abstract
Multiply injured child is a unique challenge to the medical communities worldwide. It is a leading cause of preventable mortality and morbidity in children. Common skeletal injuries include closed or open fractures of tibia and femur and pelvic injuries. Initial management focuses on saving life and then saving limb as per pediatric advanced life support and advanced trauma life support. Orthopedic management of open fracture includes splinting the limb, administration of prophylactic antibiotic, and surgical debridement of the wound when safe. However, gross contamination, compartment syndrome, and vascular injuries demand urgent attention.
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Affiliation(s)
- Om Lahoti
- Department of Trauma and Orthopaedics, King's College Hospital, Denmark Hill, London, UK,Address for correspondence: Dr. Om Lahoti, King's College Hospital, Denmark Hill, London SE5 9RS, UK. E-mail:
| | - Anand Arya
- Department of Trauma and Orthopaedics, King's College Hospital, Denmark Hill, London, UK
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