Paediatric trauma in Spain: a report from the HUGM Trauma Registry

Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study

BACKGROUND

Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies.

METHODS

A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis.

RESULTS

A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12-15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. Conclusions: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention.

Epidemiology of major paediatric trauma in a European Country - trends of a decade

OBJECTIVES

This study investigates causes, characteristics and temporal trends of paediatric major trauma over a 10-year period and assesses potential preventive areas.

METHODS

Single-centre retrospective study of paediatric trauma patients admitted to a Paediatric Intensive Care Unit (PICU) in a tertiary university hospital in Europe with a level 1 paediatric trauma centre, from 2009 to 2019. Paediatric major trauma patients were defined as patients aged < 18 years with Injury Severity Score > 12, admitted for intensive care for more than 24 h following trauma. Demographic, social and clinical information, including place and mechanism of trauma, injury pattern, pre-hospital and in-hospital procedures, and length of stay in PICU was extracted from PICU medical records.

RESULTS

Total 358 patients included (age 11 ± 4,9 years; 67% male); 75% were involved in road traffic accidents: 30% motor vehicle collision, 25% pedestrian, 10% motorcycle and bicycle each. Falls from height injured 19% of children, 4% during sports activities. Main injuries were to head/neck (73%) and extremities (42%). The incidence of major trauma was highest in teenagers and did not show a decreasing trend during the study years. All fatalities (1,7%; n = 6) were related to head/neck injuries. Motor vehicle collisions resulted in higher need for blood transfusion (9 vs. 2 mL/kg, p = 0,006) and the highest ICU-mortality (83%; n = 5). Children in motorcycle accidents had longer ICU length-of-stay (6,4 vs. 4,2 days, p = 0,036). Pedestrians had 25% higher risk of head/neck injuries (RR 1,25; 1,07 - 1,46; p = 0,004), and higher incidence of severe brain injury (46% vs. 34%, p = 0,042). Most children in motor-vehicle/bicycle accidents were not using restraints/protective devices (45%) or were using them inappropriately (13%).

CONCLUSIONS

Over the last decade, the absolute numbers of paediatric major trauma did not decrease. Road traffic accidents remain the leading cause of injury and death. Teenagers are at highest risk for severe trauma. Appropriate use of child restraints and protective equipment remain key for prevention.

Road Traffic Accidents, Climbing Frames, or Trampolines: What Harms Children in the 2020s?

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.

Pediatric Trauma in The Netherlands: Incidence, Mechanism of Injury and In-Hospital Mortality

BACKGROUND

In the Netherlands, there are no specialized or certified pediatric trauma centers, especially for severely injured children. National and regional agreements on centralization of pediatric trauma care are scarce. This study aims to describe the incidence, injury mechanism and in-hospital mortality of pediatric trauma in the Netherlands, as a prelude to the further organization of pediatric trauma care.

METHODS

A retrospective cohort analysis of data from the Dutch National Trauma Registry in 2009-2018, concerning all children (0-16 years) hospitalized due to injury in the Netherlands.

RESULTS

The annual number of admitted injured children increased from 8666 in 2009 to 13,367 in 2018. Domestic accidents were the most common cause of non-fatal injury (67.9%), especially in children aged 0-5 years (89.2%). Severe injury (injury severity score ≥  16) accounted for 2.5% and 74% of these patients were treated in level-1 trauma centers. In both deceased and surviving patients with severe injuries, head injuries were the most common (72.1% and 64.3%, respectively). In-hospital mortality after severe injury was 8.2%. Road-traffic accidents (RTAs) were the leading cause of death (46.5%).

CONCLUSIONS

Domestic accidents are the most common cause of injury, especially in younger children, whereas RTAs are the lead cause of fatal injury. Severe pediatric trauma in the Netherlands is predominantly managed in level-1 trauma centers, where a multidisciplinary team of experts is available. Improving the numbers of severely injured patients primarily brought to level-1 trauma centers may help to further reduce mortality.

The characteristics, management and outcomes of high- and low-grade renal injuries in paediatric trauma patients at a major trauma centre

Introduction

Children, given anatomical variations, are at increased risk of renal injury following trauma. The management of paediatric renal injuries has, similar to other solid organ injuries, largely shifted towards conservative management; however, hemodynamically unstable patients may still warrant surgical exploration or interventional techniques. The aim of this study is to describe the local incidence, demographics, morbidity and outcomes associated with high- and low-grade renal injury in a paediatric major trauma population.

Method

This was a 5-year retrospective review of trauma registry data and chart analysis of all paediatric renal injuries from major trauma at a North American level 1 paediatric trauma centre between January 2016–31 December 2020. Data was analysed using SPSS v27 with p < 0.05 considered significant.

Results

Of 1334 major trauma patients, 45 suffered a kidney injury (20 high-grade and 25 low-grade injuries), of which 93.3% underwent conservative management with no difference in outcomes between groups. 80% of patients had concurrent injuries (a quarter requiring surgery for these), with a trend towards higher rates of chest injuries in high-grade renal injury patients ( p = 0.08). Bicycle injuries were statistically more likely to cause high-grade renal injury ( p = 0.02). Angiography was utilized infrequently (3/45 patients, 6.6%), and no patients underwent embolization in our study population. Overall mortality (4.4%) and length of stay were unaffected by grade of injury.

Conclusion

Paediatric renal injury is an uncommon injury in major trauma patients (3.4%). Most cases can be managed conservatively regardless of the grade of injury. Renal injury patients are likely to have concurrent injuries, often requiring surgery. Further studies are needed to measure the success and utilization of interventional radiology techniques for management in children.

Ten-Year in-Hospital Mortality Trends among Paediatric Injured Patients in Japan: A Nationwide Observational Study

Injury is a major cause of worldwide child mortality. This retrospective nationwide study aimed to evaluate the characteristics of paediatric injured patients in Japan and their in-hospital mortality trends from 2009 to 2018. Injured patients aged <17 years were enrolled. Data were extracted from the Japan Trauma Data Bank. In the Cochran-Armitage test, in-hospital mortality significantly decreased during the study period (p < 0.001), except among patients <1 year old, and yearly reductions were observed among those with an Injury Severity Score ≥16 and survival rate ≥50% (p < 0.001). In regression analyses, patients who underwent urgent blood transfusion within 24 h after hospital admission (odds ratio (OR) = 3.24, 95% confidence interval (CI) = 2.38–4.41) had a higher in-hospital mortality risk. Higher survival probability as per the Trauma and Injury Severity Score was associated with lower in-hospital mortality (OR = 0.92, 95% CI = 0.91–0.92), a risk which decreased from 2009 to 2018 (OR = 6.16, 95% CI = 2.94–12.88). Based on our results, there is a need for improved injury surveillance systems for establishment of injury prevention strategies along with evaluation of the quality of injury care and outcome measures.

Epidemiology, Patterns of treatment, and Mortality of Pediatric Trauma Patients in Japan

Limited information exists regarding the epidemiology, patterns of treatment, and mortality of pediatric trauma patients in Japan. To evaluate the characteristics and mortality of pediatric trauma patients in Japan, especially in traffic accidents. This was a retrospective cohort study between 2004 and 2015 from a nationwide trauma registry in Japan. Pediatric trauma patients divided into four age groups: <1 years; 1 ≤ 5 years; 6 ≤ 10 years; and 11 ≤ 15 years. Data on patients' demographics, trauma mechanism and severity, treatments and in-hospital mortality were analyzed between the groups. There were 15,441 pediatric trauma patients during the study period. Among 15,441 pediatric patients, 779 belonged to the <1 year age group, 3,933 to the 1 ≤ 5 years age group, 5,545 to the 6 ≤ 10 age group, and 5,184 to the 11 ≤ 15 years age group. Male injuries (69%) were more frequent than female injuries. Head injuries (44%) were the most frequent and severe. Traffic accidents were the leading cause of trauma (44%). Overall in-hospital mortality was 3.9% and emergency department mortality was 1.4%. In-hospital mortality was 5.3%, 4.7%, 3.0% and 4.0% for the <1 year, 1 ≤ 5 years, 6 ≤ 10 years, and 11 ≤ 15 years age groups respectively. A total of 57% of all trauma deaths were before or upon arrival at hospital. Traffic accidents for the <1 year age group was the highest category of mortality (15%). The overall in-hospital mortality of Japanese pediatric trauma patients was 3.9% based on the nationwide trauma registry of Japan. The main cause of severe trauma was traffic accidents, especially in patients <1 year of age whose mortality was 15%.

Accidents due to falls from roof slabs

CONTEXT AND OBJECTIVE Falls from the roof slabs of houses are accidents of high potential severity that occur in large Brazilian cities and often affect children and adolescents. The aims of this study were to characterize the factors that predispose towards this type of fall involving children and adolescents, quantify the severity of associated lesions and suggest preventive measures. DESIGN AND SETTING Descriptive observational prospective longitudinal study in two hospitals in the metropolitan region of São Paulo. METHODS Data were collected from 29 cases of falls from roof slabs involving children and adolescents between October 2008 and October 2009. RESULTS Cases involving males were more prevalent, accounting for 84%. The predominant age group was schoolchildren (7 to 12 years old; 44%). Leisure activities were most frequently being practiced on the roof slab at the time of the fall (86%), and flying a kite was the most prevalent game (37.9%). In 72% of the cases, the children were unaccompanied by an adult responsible for them. Severe conditions such as multiple trauma and traumatic brain injuries resulted from 79% of the accidents. CONCLUSION Falls from roof slabs are accidents of high potential severity, and preventive measures aimed towards informing parents and guardians about the dangers and risk factors associated with this type of accident are needed, along with physical protective measures, such as low walls around the slab and gates with locks to restrict free access to these places.

Characteristics of pediatric trauma in an urban city in Japan

OBJECTIVES

To clarify the characteristics of recent pediatric injuries in an urban city in Japan.

METHODS

Any patient who was under 13 years old and admitted for treatment of trauma between January 2000 and December 2007 was retrospectively investigated. The subjects were divided into 2 groups, the head injury (HI) and the control groups. The HI group had an abbreviated injury score (AIS) of the head greater than 1, and the control group had an AIS of the head equal to 0 or 1.

RESULTS

The number of patients in the HI group was 95; and in the control group, 74. There were no penetrating injuries. The proportion of patients who were run over in the HI group was smaller than that in the control group. The injury severity score in the HI group was greater than that in the control group. The abdominal AIS in the HI group was smaller than that in the control group. The number of extracranial injuries (sum of all AIS except for the head) in the HI group was smaller than that in the control group. The survival rate in the HI group was smaller than that in the control group. All causes of death in the HI group were cerebral complications.

CONCLUSIONS

The severity and outcome of pediatric blunt traumas were dependent on HI. Because the extracranial injuries with an HI were not severe, the successful treatment of the cerebral complications could lead to favorable outcome.

Risk-Inducing Activities Leading to Injuries in a Child and Adolescent Population of Germany

BACKGROUND

Injuries are the most common cause of mortality in children, also accounting considerably for childhood morbidity. However, data on injuries only provide valid information on the actual risk of each injury-causing activity when taken in consideration of the relationship with actual activity exposure data. Therefore, the primary goal of this investigation is to determine the relative risk of normal child and adolescent activities.

METHODS

From January 1, 1999 to December 31, 2001, a school questioning in regard to social, pedagogic, and leisure activities was performed among 2,325 students ranging from 6 to 17 years old. A total of 3,645 injuries sustained by children and adolescents treated at the surgical emergency department of the University Hospital Dresden were analyzed. Furthermore, a danger awareness test was performed.

RESULTS

Forty-three percent of all injuries happened during leisure time, 41% at school, 8% in traffic, and 8% at home. Bicycle riding was pointed out as the most frequent leisure activity, regardless of gender and age. Horse riding had a 9-fold increased risk and moped driving had a 23.75-fold increased risk for injury compared with adolescent bike riding. Horse riding and snowboarding showed an increased risk for injury in children (5.6- and 4.2-fold, relative to biking). The level of danger awareness was significantly lower in children with a history of frequent injuries.

CONCLUSIONS

The riskier activities were horse-riding, moped driving, and snowboarding. The level of danger awareness did affect the frequency of injuries. The authors recommend a danger awareness test for all children to identify those who would benefit from injury prevention training.