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Narrowing the Focus: Autopsy Reports Provide Clarity in Pediatric Trauma Deaths
Nicole Fox, MD, MPH, Stacey Staman, RN, MSN, Joshua Hazelton, DO. Cooper University Health Care, Camden, NJ, USA.

Background: The critical review of pediatric trauma deaths can identify opportunities for improvement in the care of injured children. We hypothesized that autopsy reports would help identify the actual cause of death, enable us to more accurately predict probability of survival and determine which cases require further review.

Methods: A retrospective review of pediatric (<15) trauma deaths (2011-2015) was conducted. Demographics, clinical characteristics, and autopsy data were collected. Injury severity (ISS) and trauma & injury severity (TRISS) scores were calculated for each patient before and after review of available autopsy reports. A p <0.05 was considered significant.

Results: There were 22 deaths (1.6% of all admissions) during the study period. Study patients were 64 years of age with an initial ISS of 2610 and primarily blunt injuries (91%). Autopsy reports were available in 16 (73%) of cases. Based on autopsy findings, 8 of 16 (50%) patients required revision of both ISS and TRISS, resulting in a significant increase in ISS and decrease in TRISS (Table 1). Autopsy results in the other 8 patients confirmed that the initial ISS and TRISS scores were accurate.

Conclusions: These results demonstrate that the review of post-mortem examinations results in a more accurate ISS and a lower probability of survival as measured by TRISS. Autopsy reports should be obtained and reviewed in all cases of pediatric traumatic death.

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