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Affiliation
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Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA. |
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Abstract
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BACKGROUND: Emergent procedures infrequent in pediatric trauma. We sought determine the frequency and efficacy of life-saving interventions (LSI) performed for pediatric trauma patients within the first hour of care at a trauma center.
METHODS: The National Trauma Data Bank (2010 - 2014) was queried for patients age ≤ 19 who underwent LSIs within 1 hour of arrival to the emergency department (ED). LSI included ED thoracotomy (EDT) and emergent airway procedures (EAP). Multivariable logistic regression was used to evaluate the influence of patient and hospital characteristics on mortality.
RESULTS: Out of 725,284 recorded traumatic encounters, only 1,488 (0.2%) of pediatric patients underwent at least one of the defined LSI during the five-year study period (EDT 1,323; EAP 187). Most patients were ≥ 15 years old (85.6%). Mortality was high but varied by procedure type (EDT 64.3%; EAP 28.3%). Mortality for patients less than 1-year old undergoing EDT was 100%, decreasing to 62.6% in patients aged 15- to 19-years. For EAP, mortality ranged from 66.7% for infants to 27.2% in 15 to 19-year-old patients. Lower Glasgow Coma Scale score, higher Injury Severity Score, presence of shock, and a blunt mechanism of injury were independently associated with mortality in the EDT cohort. On average, trauma centers in this study performed approximately 1 LSI per year, with only 13.8% of cases occurring at a verified pediatric trauma center.
CONCLUSION: LSIs in the pediatric trauma population are uncommon and outcomes variable. Novel solutions to keep proficient at such interventions should be sought, especially for younger children. Guidelines to improve identification of appropriate candidates for LSI are critical given their rare occurrence. LEVEL OF EVIDENCE: III - Retrospective cohort study.
Language: en |